Abstract
Improved health care services can benefit from a more seamless exchange of medical information between patients and health care providers. This exchange is especially important considering the increasing trends in mobility, comorbidity and outbreaks. However, current Electronic Health Records (EHR) tend to be institution-centric, often leaving the medical information of the patient fragmented and more importantly inaccessible to the patient for sharing with other health providers in a timely manner. Nearly a decade ago, several client–server models for personal health records (PHR) were proposed. The aim of these previous PHRs was to address data fragmentation issues. However, these models were not widely adopted by patients. This paper discusses the need for a new PHR model that can enhance the patient experience by making medical services more accessible. The aims of the proposed model are to (1) help patients maintain a complete lifelong health record, (2) facilitate timely communication and data sharing with health care providers from multiple institutions and (3) promote integration with advanced third-party services (e.g., risk prediction for chronic diseases) that require access to the patient’s health data. The proposed model is based on a Peer-to-Peer (P2P) network as opposed to the client–server architecture of the previous PHR models. This architecture consists of a central index server that manages the network and acts as a mediator, a peer client for patients and providers that allows them to manage health records and connect to the network, and a service client that enables third-party providers to offer services to the patients. This distributed architecture is essential since it promotes ownership of the health record by the patient instead of the health care institution. Moreover, it allows the patient to subscribe to an extended range of personalized e-health services.
Highlights
Access to the complete medical history of the patient is becoming increasingly crucial for the delivery of quality medical services
Example commercial Electronic Health Records (EHR) systems that have been deployed in various health care institutions include
This paper proposes a new personal health records (PHR) architecture and demonstrates the ability of this architecture to fulfil the functional needs of the patients, the health care institutions and third-party e-health services
Summary
Access to the complete medical history of the patient is becoming increasingly crucial for the delivery of quality medical services. EPIC [4], Cerner [5], and Meditech [6] These systems are able to digitize processes and workflows. They each use different data representations which makes it difficult to seamlessly exchange health records between institutions that use different EHRs. In order to overcome this interoperability gap, standard data representations and ontologies (e.g., HL7 [7], FHIR [8]) have been developed. In a client–server architecture, clients connect to a central server [34] and exchange records directly with the server. Most of the early PHR solutions were based on a client–server architecture. Some of these solutions are described in [20,35,36]. A PHR focusing on medication history using blockchain over a P2P network was introduced in [40]
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