Electronic Health Record Exchange Research Articles

FACTORS ASSOCIATED WITH ELECTRONIC HEALTH RECORD ADOPTION AMONG ADULT DAY SERVICES IN THE US

Abstract Successful adoption of Electronic Health Records (EHR) is becoming increasingly important for Adult Day Service Centers (ADSC) to function effectively and competently, particularly in care coordination with other healthcare providers. Therefore, in the present study, we assessed the EHR adoption among ADSC and its associated organizational characteristics using the 2018 National Study of Long-Term Care Providers (NPALS). The sample included 4,035 ADSC from a national representative sample. Directors or managers of ADSC completed the survey that included questions on organization characteristics, staffing, practice procedures, services, technology use, etc. Findings reveal that the adoption rate of EHR among ADSC was less than thirty percent and less than twenty percent of ADSC used EHR for health information exchange with either physicians or pharmacists. In addition, we found that an ADSC located near other healthcare providers, with Medicaid authorization and a higher percentage of Medicaid patients, and various computer capabilities such as recording participants’ demographic information, clinical notes, medications, service plans, and lab results were related to a higher likelihood of EHR use and EHR exchange. However, possibly due to privacy concerns, the capabilities to record participant problems and view lab results, negatively predict EHR exchange with physicians or pharmacists. The findings are discussed in terms of challenges and strategies to promote EHR adoption in ADSC.

A hackathon as a tool to enhance research and practice on electronic health record systems' interoperability for chronic disease management and prevention.

The development of a standardized technical framework for exchanging electronic health records is widely recognized as a challenging endeavor that necessitates appropriate technological, semantic, organizational, and legal interventions to support the continuity of health and care. In this context, this study delineates a pan-European hackathon aimed at evaluating the efforts undertaken by member states of the European Union to develop a European electronic health record exchange format. This format is intended to facilitate secure cross-border healthcare and optimize service delivery to citizens, paving the way toward a unified European health data space. The hackathon was conducted within the scope of the X-eHealth project. Interested parties were initially presented with a representative clinical scenario and a set of specifications pertaining to the European electronic health record exchange format, encompassing Laboratory Results Reports, Medical Imaging and Reports, and Hospital Discharge Reports. In addition, five onboarding webinars and two professional training events were organized to support the participating entities. To ensure a minimum acceptable quality threshold, a set of inclusion criteria for participants was outlined for the interested teams. Eight teams participated in the hackathon, showcasing state-of-the-art applications. These teams utilized technologies such as Health Level Seven-Fast Healthcare Interoperability Resources (HL7 FHIR) and Clinical Document Architecture (CDA), alongside pertinent IHE integration profiles. They demonstrated a range of complementary uses and practices, contributing substantial inputs toward the development of future-proof electronic health record management systems. The execution of the hackathon demonstrated the efficacy of such approaches in uniting teams from diverse backgrounds to develop state-of-the-art applications. The outcomes produced by the event serve as proof-of-concept demonstrators for managing and preventing chronic diseases, delivering value to citizens, companies, and the research community.

User acceptability of blockchain technology for enabling electronic health record exchange

PurposeBlockchain systems have been proposed as a solution for exchanging electronic health records (EHR) because they enable data sharing in decentralised networks. This paper aims to analyse the user acceptability of blockchain technology in enabling EHR exchange and to formulate practical implications for increasing user acceptability.Design/methodology/approachA technology acceptance model [extended Unified Theory of Acceptance and Use of Technology (UTAUT) model] was used as a framework to measure the effects of 13 factors. The authors conducted a survey and analysed data from 214 participants using partial least square path modelling.FindingsThe acceptance of blockchain for EHR sharing is positively influenced by performance expectancy, social influence and perceived trust. Effort expectancy and facilitating conditions do not influence acceptance. The UTAUT model explains the variance in acceptance at 58.4%. Self-efficacy influences effort expectancy, incentives influence facilitating conditions and security predicts perceived trust.Practical implicationsThree implications are drawn: (1) Users need to clearly understand system’s purpose, functions, security mechanism and environmental impacts. (2) Users are incentivised to share health data via a blockchain solution if the technology offers personalising options and health information. (3) Health personnel can socially impact patients to use blockchain-based solutions.Originality/valueStudies have shown that blockchain technology is a valuable solution for exchanging EHR. The novelty of this work is to identify how and why patients may accept this emerging technology for EHR exchange.

The development of new Electronic Health Record Exchange Format Use Cases - an evaluating perspective

Abstract The EU-funded X-eHealth project aims to lay the foundations for a common framework for medical imaging, discharge letters, laboratory results and rare diseases to advance an interoperable Common European Health Data Space for citizens and healthcare providers in accordance with privacy and cybersecurity regulations. To ensure sustainability of the project, it is crucial to assess whether X-eHealth is achieving its planned objectives and delivers tangible results. A key challenge in evaluating project outcomes lies in the partial lack of visibility of direct impacts due to a time lag of effects or attribution problems (i.e., identifying the main cause of a particular impact). In X-eHealth, we address this problem by defining a framework of Key Performance Indicators (KPI) that allows the monitoring of project outcomes. In addition, qualitative interviews with a focus on the following questions are conducted towards the end of the project to complement the evaluation: • Does X-eHealth advance the integration process of eHealth services in Europe? • Will X-eHealth lead to increased use of the new European Electronic Health Record Exchange Format (EEHRxF) specifications? Although final results are not yet available, we expect X-eHealth to have a positive impact at all stakeholder levels by accelerating the implementation of EEHRxF through the harmonisation of health data, thus providing patients, health professionals and institutions with increased quality, safety and efficiency. There is little evidence to analyse the impact of eHealth policy interventions. For this reason, the present evaluation makes a significant contribution to impact research in this area. X-eHealth highlights the importance of international cooperation in creating a common framework for the future development of digital health in the EU. The continuous evaluation, moreover, facilitates a more efficient management of resources through KPI observance and the implementation of project results. Key messages • X-eHealth aims to accelerate the implementation of the European eHealth Record exchange Format (EEHRxF) through the standardisation and harmonisation of health data. • By evaluating and monitoring the project processes, it is possible to ensure the progress of the project and to measure the potential impacts of the outcomes on stakeholders and other target groups.

Digitalization of Health Data: Interoperability of the Proposed European Health Data Space.

On May 3rd, 2022, the European Commission published its legislative proposal to create a European Health Data Space (EHDS) enabling citizens of the European Union to gain secure access to their electronic health data by establishing a market for digital health. This market will feature the primary and secondary use of electronic health records by digital products and services. The articles of the proposal address many aspects of ensuring health data interoperability. That includes the creation of a European Electronic Health Record Exchange Format for defined data categories including patient summaries and electronic prescriptions, the development of a central platform to provide a cross-border digital infrastructure and that each Member State institutes a digital health authority and a national point of contact. In addition, the Commission will define common specifications that electronic health record systems and medical devices will have to meet as interoperability requirements. In its current form, the proposal does not stipulate specific standards that need to be universally adopted to ensure semantic and syntactical interoperability. Considering that many datasets are not internationally harmonized and lack standardization, these specifications will need to be provided for example by existing standards like the International Patient Summary.

Patient's data privacy protection in medical healthcare transmission services using back propagation learning

Medical healthcare services rely on communication technologies for exchanging digital records of patients. The new digitalizing of health records brings a specific change in healthcare services. The Electronic Health Records (EHRs) contains cumulative information about patients, such as medical history, observations, diagnostics, specimens, and reports. EHRs are sensitive information readily available for patient's and healthcare providers’ access while maintaining privacy. Therefore, preserving security and privacy is of utmost importance for healthcare systems since it reduces the impact of adversaries on EHR exchange and transmissions through wearable antennas. This research introduces Healthcare Data Privacy (HDP) through Backpropagation Learning (BL) to improve privacy maintenance in medical healthcare transmission services using wearable devices. The proposed method identifies the need for encrypting and decrypting the accumulated healthcare data based on data integrity verifications. It operates on two levels for verifying the security measures to prevent data losses in successive transmissions of wearable devices.

Can the European EHR Exchange Format Support Shared Decision Making and Citizen-Driven Health Science?

The European Commission published in 2019 the Recommendation on the European Electronic Health Record exchange format (EHRxF) to support citizens and healthcare providers in securely accessing and sharing EHRs. The European EHRxF is expected to contribute to the digital transformation of health and care in the digital single market empowering citizens and building a healthier society. This paper presents areas of work that need to be resolved for the European EHRxF to advance shared decision-making for patients and citizen-centered science.

International Patient Summary Standards conveying immunization information

International Patient Summary (IPS) Standards represent a collaborative effort among Standards Development Organizations i.e. HL7, CEN, ISO, IHE to extract a snapshot of key information from Electronic Health Records including key conditions, allergies, medications, as well as immunization information. This information is associated with provenance information regarding when and how this information was produced, and who attests to its validity. Many mobile handset manufacturers support this functionality by default and empower citizens to receive safe care where and when needed. Patient summaries are also one of the key functionalities supported by Connected Europe, eHealth Digital Services Infrastructure, operated by European Union member states and the most recent initiative regarding the European Electronic Health Record Exchange Format, which explicitly includes laboratory observations (test results). With COVID-19 the immunization section of the IPS standard comes to play a critical role, empowering individuals to access and manage data related to their immunity, such as the tests carried out and their outcome. Additionally, consideration will be given to a key related question is how to standardize the representation of COVID19 tests and associated results. Already, the standards organizations SNOMEDCT International, LOINC, and CDISC have released guidance related to terminology and nomenclature.

An Assessment of the Interoperability of Electronic Health Record Exchanges Among Hospitals and Clinics in Taiwan.

BackgroundThe rapid aging of the Taiwanese population in recent years has led to high medical needs for the elderly and increasing medical costs. Integrating patient information through electronic health records (EHRs) to reduce unnecessary medications and tests and enhance the quality of care has currently become an important issue. Although electronic data interchanges among hospitals and clinics have been implemented for many years in Taiwan, the interoperability of EHRs has not adequately been assessed.ObjectiveThe study aimed to analyze the efficiency of data exchanges and provide suggestions for future improvements.MethodsWe obtained 30 months of uploaded and downloaded data of EHRs among hospitals and clinics. The research objects of this study comprised 19 medical centers, 57 regional hospitals, 95 district hospitals, and 5520 clinics. We examined 4 exchange EHR forms: laboratory test reports, medical images, discharge summaries, and outpatient medical records. We used MySQL (Oracle Corporation) software (to save our data) and phpMyAdmin, which is a Personal Home Page program, to manage the database and then analyzed the data using SPSS 19.0 statistical software.ResultsThe quarterly mean uploaded volume of EHRs among hospitals was 52,790,721 (SD 580,643). The quarterly mean downloaded volume of EHRs among hospitals and clinics was 650,323 (SD 215,099). The ratio of uploaded to downloaded EHRs was about 81:1. The total volume of EHRs was mainly downloaded by medical centers and clinics, which accounted for 53.82% (mean 318,717.80) and 45.41% (mean 269,082.10), respectively, and the statistical test was significant among different hospital accreditation levels (F2=7.63; P<.001). A comparison of EHR download volumes among the 6 National Health Insurance (NHI) branches showed that the central NHI branch downloaded 11,366,431 records (21.53%), which was the highest, and the eastern branch downloaded 1,615,391 records (3.06%), which was the lowest. The statistical test among the 6 NHI branches was significant (F5=8.82; P<.001). The download volumes of laboratory tests reports and outpatient medical records were 26,980,425 (50.3%) and 21,747,588 records (40.9%), respectively, and were much higher than medical images and discharge summaries. The statistical test was also significant (F=17.72; P<.001). Finally, the download time showed that the average for x-rays was 32.05 seconds, which was the longest, and was 9.92 seconds for electrocardiogram, which was the shortest, but there was no statistically significant difference among download times for various medical images.ConclusionsAfter years of operation, the Electronic Medical Record Exchange Center has achieved the initial goal of EHR interoperability, and data exchanges are running quite stably in Taiwan. However, the meaningful use of EHRs among hospitals and clinics still needs further encouragement and promotion. We suggest that the government’s leading role and collective collaboration with health care organizations are important for providing effective health information exchanges.

Enhancing Privacy Controls for Patients via a Selective Authentic Electronic Health Record Exchange Service: Qualitative Study of Perspectives by Medical Professionals and Patients.

BackgroundPatients’ privacy is regarded as essential for the patient-doctor relationship. One example of a privacy-enhancing technology for user-controlled data minimization on content level is a redactable signature. It enables users to redact personal information from signed documents while preserving the validity of the signature, and thus the authenticity of the document. In this study, we present end users’ evaluations of a Cloud-based selective authentic electronic health record (EHR) exchange service (SAE-service) in an electronic health use case. In the use case scenario, patients were given control to redact specified information fields in their EHR, which were signed by their doctors with a redactable signature and transferred to them into a Cloud platform. They can then selectively disclose the remaining information in the EHR, which still bears the valid digital signature, to third parties of their choice.ObjectiveThis study aimed to explore the perceptions, attitudes, and mental models concerning the SAE-service of 2 user roles: signers (medical professionals) and redactors (patients with different technical knowledge) in Germany and Sweden. Another objective was to elicit usability requirements for this service based on the analysis of our investigation.MethodsWe chose empirical qualitative methods to address our research objective. Designs of mock-ups for the service were used as part of our user-centered design approach in our studies with test participants from Germany and Sweden. A total of 13 individual walk-throughs or interviews were conducted with medical staff to investigate the EHR signers’ perspectives. Moreover, 5 group walk-throughs in focus groups sessions with (N=32) prospective patients with different technical knowledge to investigate redactor’s perspective of EHR data redaction control were used.ResultsWe found that our study participants had correct mental models with regard to the redaction process. Users with some technical models lacked trust in the validity of the doctor’s signature on the redacted documents. Main results to be considered are the requirements concerning the accountability of the patients’ redactions and the design of redaction templates for guidance and control.ConclusionsFor the SAE-service to be means for enhancing patient control and privacy, the diverse usability and trust factors of different user groups should be considered.

Consent-based access control for secure and privacy-preserving health information exchange

Electronic health record exchanges are crucial functions of modern healthcare systems. These components are fundamental in providing quality care and enable for a larger spectrum of services. A framework which protects patient information during data exchanges is essential for healthcare systems. To achieve security and privacy-preservation for information exchange, we propose a consent-based access control CBAC mechanism for healthcare systems. A consent is an authorization initiated by a patient for an intended data requester via an agreement between them. After obtaining the consent from the patient, a healthcare organization can gain access to the data, which is encrypted by a healthcare provider. This is achieved by a cryptographic primitive: conditional proxy re-encryption. By doing so, patient medical data is protected against access of unauthorized parties, including public data center. Additionally, the proposed scheme achieves collusion resistance. Furthermore, mutual authentication and contextual privacy are attained. Performance evaluation demonstrates that the proposed CBAC scheme can achieve security and privacy preservation with high computational efficiency. Copyright © 2016 John Wiley & Sons, Ltd.

Physicians’ Acceptance of Electronic Health Records Exchange: An Extension of the with UTAUT2 Model Institutional Trust

Physicians’ Acceptance of Electronic Health Records Exchange: An Extension of the with UTAUT2 Model Institutional Trust

Security Analysis of Standards-Driven Communication Protocols for Healthcare Scenarios

The importance of the Electronic Health Record (EHR), that stores all healthcare-related data belonging to a patient, has been recognised in recent years by governments, institutions and industry. Initiatives like the Integrating the Healthcare Enterprise (IHE) have been developed for the definition of standard methodologies for secure and interoperable EHR exchanges among clinics and hospitals. Using the requisites specified by these initiatives, many large scale projects have been set up for enabling healthcare professionals to handle patients' EHRs. The success of applications developed in these contexts crucially depends on ensuring such security properties as confidentiality, authentication, and authorization. In this paper, we first propose a communication protocol, based on the IHE specifications, for authenticating healthcare professionals and assuring patients' safety. By means of a formal analysis carried out by using the specification language COWS and the model checker CMC, we reveal a security flaw in the protocol thus demonstrating that to simply adopt the international standards does not guarantee the absence of such type of flaws. We then propose how to emend the IHE specifications and modify the protocol accordingly. Finally, we show how to tailor our protocol for application to more critical scenarios with no assumptions on the communication channels. To demonstrate feasibility and effectiveness of our protocols we have fully implemented them.

Building a portable data and information interoperability infrastructure—framework for a standard Taiwan Electronic Medical Record Template

Traditional electronic health record (EHR) data are produced from various hospital information systems. They could not have existed independently without an information system until the incarnation of XML technology. The interoperability of a healthcare system can be divided into two dimensions: functional interoperability and semantic interoperability. Currently, no single EHR standard exists that provides complete EHR interoperability. In order to establish a national EHR standard, we developed a set of local EHR templates. The Taiwan Electronic Medical Record Template (TMT) is a standard that aims to achieve semantic interoperability in EHR exchanges nationally. The TMT architecture is basically composed of forms, components, sections, and elements. Data stored in the elements which can be referenced by the code set, data type, and narrative block. The TMT was established with the following requirements in mind: (1) transformable to international standards; (2) having a minimal impact on the existing healthcare system; (3) easy to implement and deploy, and (4) compliant with Taiwan's current laws and regulations. The TMT provides a basis for building a portable, interoperable information infrastructure for EHR exchange in Taiwan.