Cloud-based Electronic Medical Record Research Articles

A secure and efficient electronic medical record data sharing scheme based on blockchain and proxy re-encryption

With the rapid development of the Internet of Medical Things (IoMT) and the increasing concern for personal health, sharing Electronic Medical Record (EMR) data is widely recognized as a crucial method for enhancing the quality of care and reducing healthcare expenses. EMRs are often shared to ensure accurate diagnosis, predict prognosis, and provide health advice. However, the process of sharing EMRs always raises significant concerns about potential security issues and breaches of privacy. Previous research has demonstrated that centralized cloud-based EMR systems are at high risk, e.g., single points of failure, denial of service (DoS) attacks, and insider attacks. With this motivation, we propose an EMR sharing scheme based on a consortium blockchain that is designed to prioritize both security and privacy. The interplanetary file system (IPFS) is used to store the encrypted EMR while the returned hash addresses are recorded on the blockchain. Then, the user can authorize other users to decrypt the EMR ciphertext via the proxy re-encryption algorithm, ensuring that only authorized personnel may access the files. Moreover, the scheme attains personalized access control and guarantees privacy protection by employing attribute-based access control. The safety analysis shows that the designed scheme meets the expected design goals. Security analysis and performance evaluation show that the scheme outperforms the comparison schemes in terms of computation and communication costs.

P880 The real-world use of five-aminosalicylate (5ASA) treatment for Ulcerative Colitis in Australia and New Zealand: Crohn’s Colitis Cure (CCC) data insight’s program

Abstract Background Five-aminosalicylates (5ASAs) promote & maintain remission in people with ulcerative colitis (UC) and are administered orally or rectally, with combination therapy (oral + rectal) more effective than oral monotherapy, especially when treating flares1. 5ASAs may be perceived as out-dated and thus neglected. With increasing UC incidence & prevalence in emerging nations, understanding real-world 5ASA use and value is vital. Methods Crohn’s Colitis Care is a cloud-based electronic medical record used in Australasia. Data feed into a de-identified clinical quality registry (CQR), which was interrogated in September 2023. People with UC under active care (encounter within 14 months) were included. Results Of the 2,522 eligible people, 78.4% resided in Australia & 21.6% in New Zealand (NZ). The median age was 41 years (IQR 31-56), with an even gender distribution (50.3% female). Median disease duration was 9 years (IQR 4.4-16.7). Median duration of follow up was 25.9 months (IQR 13.0-41.4). Overall, 39.2% (n=989) had no documentation of 5ASA therapy (42.0% in Australia, 28.9% in NZ; Table 1). In those with documented 5ASA therapy (60.8%, n=1,534), the average 5ASA treatment duration was 9 years (IQR 4.4-16.7) and women were more likely to receive rectal administration than men (p<0.05). In those who ceased 5-ASA therapy, 782 (44.8%) had a reason documented, with the most common being medication rationalisation and/or deep remission (40.0%) (Figure 1), usually due to up-titration to a more advanced therapy. A total of 608 (39.6%) were recorded as already receiving additional IBD therapy at CQR entry (immunomodulators [IMs]/biologics/small molecules). Of those receiving 5ASAs alone at CQR entry (n=926), 5ASAs were subsequently judged to have failed in 37.8% (n=350). 5ASA failure was defined as the need for additional IBD therapies (99.1%, n=230 for IMs/biologics/small molecules and n=117 for steroids, total n=347); hospitalisation (n=3, 0.9%) or IBD surgery (n=0). Conclusion Despite not working for everyone, the long duration of 5ASA therapy indicates they are well tolerated & perceived as beneficial by consumers. There was greater 5ASA utilisation in NZ, possibly due to restricted advanced therapy access. Gender-specific trends in 5ASA administration were identified, raising the question as to why this should be so, given this is not obviously explained by disease phenotype. Further analysis is needed to tease out how such trends interact with other therapeutic access, choices and outcomes. 1 - Probert C et a. Combined oral and rectal mesalazine for the treatment of mild-to-moderately active ulcerative colitis: rapid symptom resolution and improvements in quality of life. J Crohns Colitis. doi:10.1016/j.crohns.2013.08.007

The Challenges and Hidden Concerns of Cloud-based Electronic Medical Record Exchange

The Challenges and Hidden Concerns of Cloud-based Electronic Medical Record Exchange

A Secure Storage and Sharing Scheme of Stroke Electronic Medical Records Based on Consortium Blockchain.

The maintenance and sharing of electronic medical records are one of the essential tasks in the medical treatment combination. Traditional cloud-based electronic medical record storage system is difficult to realize data security sharing. The tamper resistance and traceability of blockchain technology provide the possibility for the sharing of highly sensitive medical data. This paper proposes a safe sharing scheme of stroke electronic medical records based on the consortium blockchain. The scheme adopts the storage method of ciphertext of medical records stored in the cloud and index of medical records stored on the blockchain. The privacy protection mechanism proposed in this paper innovatively combines proxy reencryption and searchable encryption which supports patient pseudoidentity search. The mechanism could achieve controllable sharing of medical records and precise search. According to the organizational characteristics of the stroke medical treatment combination, this paper proposes an improved Practical Byzantine Fault Tolerance mechanism to reach a consensus between consensus nodes. Then, the proposed scheme is analyzed and evaluated from three aspects of medical record integrity, user privacy, and data security. The results show that the scheme can not only ensure the privacy of patient identity information and private key data but also resist the tampering and deletion attacks of internal and external malicious nodes on the medical record data. Therefore, the proposed scheme is conducive to the improvement of the timeliness of stroke treatment and the safe sharing of electronic medical records in stroke medical treatment combination.

Multicopy provable data possession scheme supporting data dynamics for cloud-based Electronic Medical Record system

In the era of big data, there are several insuperable research challenges in establishing Electronic Medical Record (EMR) for updating massive data with traditional methods. It is an attractive option to create the cloud-based EMR system, since cloud provides elastic and affordable data storage and management services. However, once the medical records are uploaded into the cloud, the owner will lose the control over the data, and sensitive contents might be accessed or modified by unauthorized entities. To address this issue, we propose a multicopy provable data possession for cloud-based EMR systems, which ensures the integrity and privacy of EMR data. In particular, to achieve data updates, we design a novel dynamic structure that improves the Merkle Hash Tree for multicopy storage, which achieves full dynamics efficiently and safely. Moreover, a random masking technique is employed in our proposal to generate distinguishable replica blocks of one block. Our construction prevents a verifier from obtaining medical records from challenge responses, but also eliminates exposing the content to unauthorized entities. Our security analysis shows that our scheme is provably secure. Evaluation experiments demonstrate that the proposal has lower communication and computation costs in comparison with the existing schemes.

Cloud-Assisted EHR Sharing With Security and Privacy Preservation via Consortium Blockchain

The sharing of electronic health records (EHRs) has great positive significance for research of disease and doctors’ diagnosis. In recent years, cloud-based electronic medical record sharing scheme has brought a lot of conveniences, but the centralization of cloud exposes threats inevitably to data security and privacy preservation. Blockchain technology can be seen as a promising solution to address these problems on account of its unique propertis of decentration, anonymity, unforgeability and verifiability. In this paper, we propose a blockchain based secure and privacy-preserving EHR sharing protocol. Data requester can search desired keyword from data provider to find relevant EHRs on the EHR consortium blockchain and get the re-encryption ciphertext from cloud server after getting the data owner’s authorization. The scheme mainly uses searchable encryption and conditional proxy re-encryption to realize data security, privacy preservation, and access control. Furthermore, proof of authorization is designed as the consensus mechanism for consortium blockchain to guarantee system’s availability. Security analysis demonstrates that the proposed protocol can achieve security goals. Besides, we emulate the cryptographic primitives and implement the proposed scheme on Ethereum platform. Performance evaluation shows that the proposed scheme has high computational efficiency.

Efficient searchable public key encryption against keyword guessing attacks for cloud-based EMR systems

Due to the tremendous benefits of cloud computing, an increasing number of health care providers tend to deploy the electronic medical record (EMR) storages and application services into cloud. To protect patients’ privacy, sensitive EMRs have to be encrypted before being uploaded to cloud. This makes effective utilization of EMRs, such as plaintext keyword search, a very challenging problem. Public key encryption with keyword search (PEKS) provides a promising cryptographic solution to encrypted EMR data retrieval, because it allows one to delegate to an untrusted storage server the capability of searching on publicly encrypted EMR data without compromising the security of original EMR data. Recently, two secure channel free PEKS schemes were proposed for cloud-based EMR systems. However, our cryptanalysis demonstrates that both of these two schemes suffer from the security vulnerabilities caused by the keyword guessing attack. To deal with this problem, a novel secure channel free PEKS scheme is developed in this paper. The proposed scheme not only provides the resistance to the existing known three types of keyword guessing attacks, but also has the merit of no designated server. In the standard model, it is formally proven to achieve both the keyword ciphertext indistinguishability and the trapdoor indistinguishability under the adaptive chosen-keyword attacks. The comparisons indicate that the scheme is secure and practicable.

Clinical Application of a Smartphone-Based Ophthalmic Camera adapter in Under-Resourced Settings in Nepal.

The ability to obtain high quality ocular images utilizing smartphone technology is of special interest in under-resourced parts of the world where traditional ocular imaging devices are cost-prohibitive, difficult to transport, and require a trained technician for operation. The purpose of this study was to explore potential anterior and posterior segment ocular imaging use cases for a smartphone-based ophthalmic camera adapter (Paxos Scope, Digisight Technologies, San Francisco, CA, USA) in under-resourced settings in Nepal. From September to November of 2015 we utilized the Paxos Scope smartphone camera adapter coupled with an iPhone 5 to explore anterior and posterior segment clinical applications for this mobile technology. We used the device at a tertiary eye care facility, a rural eye hospital and a rural cataract outreach camp. We tested the device's capability for high quality photo-documentation in clinic, in the operating room, and in the outreach camp setting. Images were automatically uploaded to a secure, cloud-based electronic medical record system that facilitated sharing of images with other providers for telemedicine purposes. Herein we present 17 ocular images documenting a wide variety of anterior and posterior segment pathology using the Paxos Scope from clinical cases seen in a variety of settings in Nepal. We found the quality of both the anterior and posterior segment images to be excellent in the clinic, the operating room, and the outreach camp settings. We found the device to be versatile and user-friendly, with a short learning curve. The Paxos Scope smartphone camera adapter may provide an affordable, high-quality, mobile ocular imaging option for under-resourced parts of the world.

Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise’s cross-enterprise document sharing integration profile

In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service.In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise’s Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system.The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system.The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios.

Toward Achieving 100% Adherence for Retinopathy of Prematurity Screening Guidelines.

To report on the use of a cloud-based electronic medical record (ROP Check; Glacier Medical Software, Anchorage, AK) designed to provide American Academy of Pediatrics (AAP) guideline-adherent retinopathy of prematurity (ROP) care through the scheduling and documenting of ROP examinations. Data analysis on 3,155 patients from a de-identified dataset from 13 neonatal intensive care units. All newborns with a gestational age of 22 to 30 weeks (N = 2,278) were entered with a documented ROP examination. Of those, 98% and 97.4% completed their initial and follow-up examinations, respectively, within AAP guidelines. All but 1 of 145 initial treatments were completed within AAP guidelines after a decision for treatment was made. Of 369 newborns older than 30 weeks' gestational age and with a birth weight of less than 1,500 grams, none progressed to treatment; four patients had stage 2 or 3 ROP. Of 508 newborns with a gestational age of 31 to 32 weeks and a birth weight of more than 1,500 grams who were entered to identify unstable newborns, 34% did not need examinations; of those who were examined, one progressed to treatment. Fourteen percent of patients were observed as outpatients before retinal maturity and 12% missed some or all outpatient appointments. A decision was made to treat at the first examination for 2 (10%) newborns with a gestational age of 22 weeks and 2 (2%) newborns with a gestational age of 23 weeks. Each patient was within the AAP guidelines for initial treatment. A computerized system specifically designed with process improvement and error-free delivery of ROP care as a focus can improve adherence to AAP guidelines and achieve superior results. Such a system creates a standardized and measurable safety net for pediatric ophthalmologists, neonatologists, hospitals, and follow-up pediatricians. [J Pediatr Ophthalmol Strabismus. 2017;54(6):356-362.].

Rapid Deployment of International Tele-Intensive Care Unit Services in War-Torn Syria.

The conflict in Syria has created the largest humanitarian emergency of the twenty-first century. The 4-year Syrian conflict has destroyed hospitals and severely reduced the capacity of intensive care units (ICUs) and on-site intensivists. The crisis has triggered attempts from abroad to support the medical care of severely injured and acutely ill civilians inside Syria, including application of telemedicine. Within the United States, tele-ICU programs have been operating for more than a decade, albeit with high start-up costs and generally long development times. With the benefit of lessons drawn from those domestic models, the Syria Tele-ICU program was launched in December 2012 to manage the care of ICU patients in parts of Syria by using inexpensive, off-the-shelf video cameras, free social media applications, and a volunteer network of Arabic-speaking intensivists in North America and Europe. Within 1 year, 90 patients per month in three ICUs were receiving tele-ICU services. At the end of 2015, a network of approximately 20 participating intensivists was providing clinical decision support 24 hours per day to five civilian ICUs in Syria. The volunteer clinicians manage patients at a distance of more than 6,000 miles, separated by seven or eight time zones between North America and Syria. The program is implementing a cloud-based electronic medical record for physician documentation and a medication administration record for nurses. There are virtual chat rooms for patient rounds, radiology review, and trainee teaching. The early success of the program shows how a small number of committed physicians can use inexpensive equipment spawned by the Internet revolution to support from afar civilian health care delivery in a high-conflict country.

Telepsychiatry Consultations in Primary Care Coordinated by Virtual Care Navigators.

Telepsychiatry Consultations in Primary Care Coordinated by Virtual Care Navigators.

Implementation of a Cloud-Based Electronic Medical Record to Reduce Gaps in the HIV Treatment Continuum in Rural Kenya.

BackgroundElectronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care in developing countries and their implementation can help to strengthen pathways of care and close gaps in the HIV treatment cascade by improving access to and use of data to inform clinical and public health decision-making.MethodsThis study implemented a novel cloud-based electronic medical record system in an HIV outpatient setting in Western Kenya and evaluated its impact on reducing gaps in the HIV treatment continuum including missing data and patient eligibility for ART. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification and clinical decision support.ResultsSignificant improvements in data quality and provision of clinical care were recorded through implementation of the EMR system, helping to ensure patients who are eligible for HIV treatment receive it early. A total of 2,169 and 764 patient records had missing data pre-implementation and post-implementation of EMR-based data verification and clinical decision support respectively. A total of 1,346 patients were eligible for ART, but not yet started on ART, pre-implementation compared to 270 patients pre-implementation.ConclusionEMR-based data verification and clinical decision support can reduce gaps in HIV care, including missing data and eligibility for ART. A cloud-based model of EMR implementation removes the need for local clinic infrastructure and has the potential to enhance data sharing at different levels of health care to inform clinical and public health decision-making. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality and provision of clinical care are recorded through implementation of this EMR model.

CloudeMR: A Cloud Based Electronic Medical Record System

The utilization of modern information technology in the delivery of healthcare is to enhance the availability and reliability of improved healthcare services to patients at a reduced cost. The alternative in this context is to outsource the computing storage resources with the help of cloud infrastructure. The drastic reduction in the cost of healthcare services, utilization of resources, maintainability and the adoption of new technologies are some of the benefits that healthcare centers in rural areas can get from cloud-based medical information system. Also, new prospects such as easy and everpresent access to medical records and the chances to make use of services of physicians that are not readily available in the rural areas are some of the opportunities offered by a cloud-based medical information system. This paper proposes and implements a cloudbased electronic medical record (CloudeMR) system to improve the delivery of healthcare system in the rural communities of Nigeria.

Implementation of a cloud-based electronic medical record for maternal and child health in rural Kenya

BackgroundComplete and timely health information is essential to inform public health decision-making for maternal and child health, but is often lacking in resource-constrained settings. Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care, and are particularly amenable to maternal and child health services. An EMR system could enable the mother and child to be tracked and monitored throughout maternity shared care, improve quality and completeness of data collected and enhance sharing of health information between outpatient clinic and the hospital, and between clinical and public health services to inform decision-making. MethodsThis study implemented a novel cloud-based electronic medical record system in a maternal and child health outpatient setting in Western Kenya between April and June 2013 and evaluated its impact on improving completeness of data collected by clinical and public health services. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification. ResultsSignificant improvements in completeness of the antenatal record were recorded through implementation of EMR-based data verification. A difference of 42.9% in missing data (including screening for hypertension, tuberculosis, malaria, HIV status or ART status of HIV positive women) was recorded pre- and post-implementation. Despite significant impact of EMR-based data verification on data completeness, overall screening rates in antenatal care were low. ConclusionThis study has shown that EMR-based data verification can improve the completeness of data collected in the patient record for maternal and child health. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality are recorded through implementation of this EMR model.

A Cloud-Based Electronic Medical Record for Scheduling, Tracking, and Documenting Examinations and Treatment of Retinopathy of Prematurity

Screening by neonatologists and staging by ophthalmologists is a cost-effective intervention, but inadvertent missed examinations create a high liability. Paper tracking, bedside schedule reminders, and a computer scheduling and reminder program were compared for speed of input and retrospective missed examination rate. A neonatal intensive care unit (NICU) process was then programmed for cloud-based distribution for inpatient and outpatient retinopathy of prematurity monitoring. Over 11 years, 367 premature infants in one NICU were prospectively monitored. The initial paper system missed 11% of potential examinations, the Windows server-based system missed 2%, and the current cloud-based system missed 0% of potential inpatient and outpatient examinations. Computer input of examinations took the same or less time than paper recording. A computer application with a deliberate NICU process improved the proportion of eligible neonates getting their scheduled eye examinations in a timely manner.