Blockchain-based Electronic Patient Records for Regulated Circular Healthcare Jurisdictions

Circular, data-driven healthcare is increasingly being considered as an effective model to provide efficient, cost-effective and sustainable healthcare services in the future. Central to this model is the service-dominant “building-block”-type provision of care services to patients, paired with the collaboration of healthcare providers through a common infrastructure. This combination enables the forming of a decentralized, holistic care cycle. Sharing of patient medical information is pivotal towards reaching this goal; however, preserving medical record integrity and privacy, while at the same time allowing provider interoperability are often conflicting requirements. Blockchains and Smart Contracts can provide the underlying technology to support the decentralized care cycle by addressing patient privacy and medical record integrity, while simultaneously offering efficient interoperability between providers. To demonstrate how this could be achieved, a conceptual medical record access and sharing mechanism is presented which is suitable for a system operating within a regulated healthcare jurisdiction

Balancing patient control and practical access policy for electronic health records via blockchain technology

Electronic health records (EHRs) have revolutionized the health information technology domain, as patient data can be easily stored and accessed within and among medical institutions. However, in working towards nationwide patient engagement and interoperability goals, recent literature adopts a very patient-centric model---patients own their universal, holistic medical records and control exactly who can access their health data. I contend that this approach is largely impractical for healthcare workflows, where many separate providers require access to health records for care delivery. My work investigates the potential of a blockchain network to balance patient control and provider accessibility with a two-fold approach. First, I conduct a survey investigation to identify patient concerns and determine the level of control patients would like over their health information. Second, I implement a blockchain network prototype to address the spectrum of patient control preferences and automate practical access policy. There are conflicting demands amongst patients and providers for EHR access---privacy versus flexibility. Yet, I find blockchain technology, when manipulated to model access states, automate an organizational role-based access scheme, and provide an immutable history of behavior in the network, to be a very plausible solution for balancing patient desires and provider needs. My approach is, to my knowledge, the first example of blockchain\u27s use for less patient-centric, nudge theory-based EHR access control, an idea that could align access control interests as academics, the government, and the healthcare industry make strides towards interoperable, universal patient records

Sistematização da análise de conformidade dos processos na área de saúde : Sariah Ester Torno Mourão

Orientadores : Prof. Dr. Ricardo Mendes Junior, Prof. Dr. José Eduardo Pécora Junior, Profª Drª Adriana de Paula Lacerda SantosCoorientador : Prof. Dr. Eduardo Alves Portela SantosDissertação (mestrado) - Universidade Federal do Paraná, Setor de Tecnologia, Programa de Pós-Graduação em Engenharia de Produção. Defesa: Curitiba, 24/02/2017Inclui referências : f. 155-164Resumo: Os processos de tratamento médico são universalmente realizados de acordo com as orientações clínicas. No entanto, existe uma lacuna entre estas orientações e a prática clínica real, ou seja, há diferenças entre as atividades executadas e as atividades recomendadas nos procedimentos. Portanto, um desafio para o setor de gestão da saúde é abordar essa lacuna. Existindo assim uma necessidade de métodos que possam medir a adesão do comportamento real do processo no que diz respeito ao comportamento esperado; identificar onde os desvios acontecem com mais frequência e; produzir resultados que possam ser facilmente compreendidos por médicos para destacar as causas mais comuns dos desvios identificados. Este é um dos objetivos da mineração de processos. A mineração de processos fornece uma imagem real do que está acontecendo, explicitando diversas perspectivas acerca das atividades, recursos e informações dos processos. Esta área de estudo está preocupada com a descoberta, monitoramento e melhoria dos processos operacionais por meio da extração de conhecimento a partir de registros gerados pelos sistemas de informação. O principal objetivo desta pesquisa é sistematizar a análise de conformidade dos processos na área da saúde tendo como estudo empírico quantitativo os processos de tratamento de pacientes com Acidente Vascular Cerebral Isquêmico (AVCI), elegíveis para trombólise endovenosa, intraarterial e mecânica, do Hospital Municipal São José, localizado na cidade de Joinville - Santa Catarina. De acordo com os estudos da Global Burden of Disease 2013 - Mortality and Causes of Death (MURRAY et al., 2015), o Acidente Vascular Cerebral (AVC) é uma das mais importantes doenças crônicas, em termos de abrangência, sendo a terceira principal causa de morte no Brasil e a principal causa de incapacidade no mundo. A sistematização proposta busca, auxiliar pesquisadores e instituições de saúde na aplicação das técnicas de descoberta e análise de conformidade dos processos na área da saúde, de modo que tais técnicas possam contribuir para a melhoria do fluxo de atividades em estabelecimentos de saúde e, consequentemente, gerar um efeito positivo sobre a saúde no Brasil. É formada por nove etapas que envolvem: o conhecimento do Sistema de Informação Hospitalar (SIH) e da base de dados; a preparação da base de dados para aplicação das técnicas de mineração de processos; o estudo dos protocolos assistenciais, procedimentos operacionais padrão, instruções de trabalho e outros documentos feitos pela instituição de saúde para o processo selecionado; o estudo das diretrizes clínicas, regulamentos, normas, leis e outros documentos que envolvem o processo escolhido; a transcrição dos documentos selecionados em notação Business Process Management and Notation; a correlação entre os protocolos assistenciais, procedimentos operacionais padrão, instruções de trabalho e outros documentos com as diretrizes clínicas, regulamentos, normas, leis e outros documentos; e por fim as análises quantitativas usando técnicas de mineração de processos, tais como, descoberta do modelo do processo real e análises de conformidade para confrontar os modelos dos processos com os registros de eventos. Palavras-chave: Mineração de Processos. Descoberta. Análise de Conformidade. Sistematização. Área da Saúde. Acidente Vascular Cerebral.Abstract: The medical treatment processes are universally performed according to clinical guidelines. However, there is a gap between these guidelines and the actual clinical practice, that is, there are differences between the activities performed and the activities recommended in the procedures. Therefore, a challenge for the health management sector is to address the gap between actual clinical processes and the recommendations given in the procedures. Thus, there is an urgent need for methods that can: measure adherence to the actual behavior of the process with respect to expected behavior; identify where deviations occur most often and; produce results that can be easily understood by physicians to highlight the most common causes of identified deviations. This is one of the objectives of process mining. Process mining provides a true picture of what is happening, spelling out diverse perspectives on process activities, resources, and information. This area of study is concerned with the discovery, monitoring and improvement of operational processes through the extraction of knowledge from records generated by information systems. The main objective of this research is to systematize the conformity analysis of the health processes, having as a quantitative empirical study the procedures for the treatment of patients with Ischemic Stroke, eligible for intravenous, intraarterial and mechanical thrombolysis, of the São José Municipal Hospital, located in the city of Joinville - Santa Catarina. According to studies by the Global Burden of Disease 2013 (MURRAY et al., 2015), stroke is one of the most important chronic diseases in terms of outreach, being the third major cause of death in Brazil and the leading cause of disability in the world. The proposed systematization seeks to assist researchers and health institutions in the application of the techniques of discovery and analysis of conformity of the processes in the health area, so that such techniques can contribute to the improvement of the flow of activities in health facilities and, consequently, positive effect on health in Brazil. It is formed by nine steps that involve: the knowledge of the Hospital Information System (SIH) and the database; the preparation of the database for application of process mining techniques; the study of care protocols, standard operating procedures, work instructions and other documents made by the health institution for the selected process; the study of clinical guidelines, regulations, norms, laws and other documents that involve the chosen process; the transcription of the documents selected in notation Business Process Management and Notation; the correlation between care protocols, standard operating procedures, work instructions and other documents with clinical guidelines, regulations, standards, laws and other documents; and finally the quantitative analyzes using process mining, such as real process model discovery and compliance analyzes to compare process models with event logs. Keywords: Process Mining. Discovery. Conformance Checker. Systematization. Healthcare. Stroke