Electronic Health Record Service Research Articles

Revocable and verifiable weighted attribute-based encryption with collaborative access for electronic health record in cloud

The encryption of user data is crucial when employing electronic health record services to guarantee the security of the data stored on cloud servers. Attribute-based encryption (ABE) scheme is considered a powerful encryption technique that offers flexible and fine-grained access control capabilities. Further, the multi-user collaborative access ABE scheme additionally supports users to acquire access authorization through collaborative works. However, the existing multi-user collaborative access ABE schemes do not consider the different weights of collaboration users. Therefore, using these schemes for weighted multi-user collaborative access results in redundant attributes, which inevitably reduces the efficiency of the ABE scheme. This paper proposes a revocable and verifiable weighted attribute-based encryption with collaborative access scheme (RVWABE-CA), which can provide efficient weighted multi-user collaborative access, user revocation, and data integrity verification, as the fundamental cornerstone for establishing a robust framework to facilitate secure sharing of electronic health records in a public cloud environment. In detail, this scheme employs a novel weighted access tree to eliminate redundant attributes, utilizes encryption version information to control user revocation, and establishes Merkle Hash Tree for data integrity verification. We prove that our scheme is resistant against chosen plaintext attack. The experimental results demonstrate that our scheme has significant computational efficiency advantages compared to related works, without increasing storage or communication overhead. Therefore, the RVWABE-CA scheme can provide an efficient and flexible weighted collaborative access control and user revocation mechanism as well as data integrity verification for electronic health record systems.

Traceable Research Data Sharing in a German Medical Data Integration Center With FAIR (Findability, Accessibility, Interoperability, and Reusability)-Geared Provenance Implementation: Proof-of-Concept Study.

Secondary investigations into digital health records, including electronic patient data from German medical data integration centers (DICs), pave the way for enhanced future patient care. However, only limited information is captured regarding the integrity, traceability, and quality of the (sensitive) data elements. This lack of detail diminishes trust in the validity of the collected data. From a technical standpoint, adhering to the widely accepted FAIR (Findability, Accessibility, Interoperability, and Reusability) principles for data stewardship necessitates enriching data with provenance-related metadata. Provenance offers insights into the readiness for the reuse of a data element and serves as a supplier of data governance. The primary goal of this study is to augment the reusability of clinical routine data within a medical DIC for secondary utilization in clinical research. Our aim is to establish provenance traces that underpin the status of data integrity, reliability, and consequently, trust in electronic health records, thereby enhancing the accountability of the medical DIC. We present the implementation of a proof-of-concept provenance library integrating international standards as an initial step. We adhered to a customized road map for a provenance framework, and examined the data integration steps across the ETL (extract, transform, and load) phases. Following a maturity model, we derived requirements for a provenance library. Using this research approach, we formulated a provenance model with associated metadata and implemented a proof-of-concept provenance class. Furthermore, we seamlessly incorporated the internationally recognized Word Wide Web Consortium (W3C) provenance standard, aligned the resultant provenance records with the interoperable health care standard Fast Healthcare Interoperability Resources, and presented them in various representation formats. Ultimately, we conducted a thorough assessment of provenance trace measurements. This study marks the inaugural implementation of integrated provenance traces at the data element level within a German medical DIC. We devised and executed a practical method that synergizes the robustness of quality- and health standard-guided (meta)data management practices. Our measurements indicate commendable pipeline execution times, attaining notable levels of accuracy and reliability in processing clinical routine data, thereby ensuring accountability in the medical DIC. These findings should inspire the development of additional tools aimed at providing evidence-based and reliable electronic health record services for secondary use. The research method outlined for the proof-of-concept provenance class has been crafted to promote effective and reliable core data management practices. It aims to enhance biomedical data by imbuing it with meaningful provenance, thereby bolstering the benefits for both research and society. Additionally, it facilitates the streamlined reuse of biomedical data. As a result, the system mitigates risks, as data analysis without knowledge of the origin and quality of all data elements is rendered futile. While the approach was initially developed for the medical DIC use case, these principles can be universally applied throughout the scientific domain.

Supporting Evidence-Based Care Through Informatics Innovation to Address the Overdose Epidemic.

Supporting Evidence-Based Care Through Informatics Innovation to Address the Overdose Epidemic.

Theil-Sen Regressive Miyaguchi–Preneel-based Cryptographic Hash Blockchain for Secure Data Transmission Using Remote Sensing Data in IoT

Based on yours suggestion, we have shortened the abstract below 250 words and is mentioned as follows, “Internet of things (IoT) is the most advanced version of the internet to maintain a number of applications that combines different intelligent devices used by management or individuals, such as remote sensing data processing, smart health with environmental monitoring, and other related fields. IoT devices interact and interfere with one another, posing a variety of security risks. Prior industrial IoT blockchain data transmission methods suffer from lower security, higher management costs for trading centres, and significant supervision challenges. To deal with this issue, Theil-Sen Regressive Miyaguchi-Preneel-based Cryptographic Hash Blockchain approach is proposed in this manuscript for securing data transmission utilizing remote sensing data in IoT (TSR-MPCHB-SDT-RSD). To enhance data transfer security, TSR-MPCHB is proposed. Remote sensing data are gathered using IoT devices. Miyaguchi-Preneel cryptographic function generates every data confusing value. It aids to enhance data privacy with an integrity ratio. The simulation of the proposed approach is done in Java. The performance metrics, namely data privacy ratio, data dependability ratio, process time average delay, average power consumption, and blockchain data transfer efficacy, is examined. The proposed approach attains higher data confidentiality rate of 31.06%, 12.24%, 15.64%, and 11.66% compared to existing such as Blockchain-Envisioned Secure Data Delivery along Collection Mode for 5G-Base IoT-Enabled Internet of Drones Context (BESDDC-IOD-RSD), BIoTHR: Electronic Health Record Service System in IoT-Blockchain Ecosystem (BIoTHR-SDT-RSD), Blockchain- LamportMerkle Digital Signature: Authentication tool in IoT healthcare (LMDSG-SDT-RSD), and Privacy Protection Blockchain Attain Safe and Dependable Sharing of IoT Data (ACOMKSVM-SDT-RSD).

Designing a Flow-based Mechanism for Accessing Electronic Health Records on a Cloud Environment

Electronic health record (EHR) implementation not only to facilitate doctor-patient communication reduces paper consumption but also allows the rapid exchange of medical records, integrating patients’ medical information from different locations. However, the costs of establishing massive and repetitive systems, constructing databases, and maintaining and exchanging data, as well as the energy consumption underscoring such an operation, represent substantial costs for a medical institution. Therefore, it is important to develop a cloud solution for EHRs and to provide a platform where resources are truly shareable. This study investigates the feasibility of cloud EHR services provided by trusted third parties. However, not only do medical records stored in an access environment with multiple users potentially endanger patient privacy, but also, without well-designed access control, such an environment may beget excessive unnecessary data access, which is costly and hinders cloud computing. To address the dual challenge of protecting patient privacy and allowing cloud computing, this study proposes the doctor–patient workflow and implements a web-based system. This mechanism ensures patients’ data security and addresses the demand of EHR cloud sharing, i.e., controlling EHR access authorities. The proposed method can protect the privacy of patients’ medical records on the cloud and grant users with minimum granularity access, thereby creating a system with the advantages of data security and cloud computing. This study proposes the doctor–patient workflow as the access control mechanism of cloud medical records, which minimizes the granularity of access. In addition, the access authority of the workflow dynamically changes with the environment, which ensures patients’ access to their medical records and defines the appropriate timing of cloud data access operations, thereby preventing unnecessary energy consumption. In practice, considerable contributions can be made to the establishment of access control and promotion of the cloud environment for medical records.

Delegated Authorization Framework for EHR Services Using Attribute-Based Encryption

Medical organizations find it challenging to adopt cloud-based Electronic Health Records (EHR) services due to the risk of data breaches and the resulting compromise of patient data. Existing authorization models follow a patient-centric approach for EHR management, where the responsibility of authorizing data access is handled at the patients end. This creates a significant overhead for the patient who must authorize every access of their health record. This is not practical given that multiple personnel are typically involved in providing care and that the patient may not always be in a state to provide this authorization. Hence there is a need to develop a proper authorization delegation mechanism for safe, secure and easy to use cloud-based EHR Service management. We present a novel, centralized, attribute-based authorization mechanism that uses Attribute Based Encryption (ABE) and allows for delegated secure access of patient records. This mechanism transfers the service management overhead from the patient to the medical organization and allows easy delegation of cloud-based EHRs access authority to medical providers.

The need for Electronic Health Records (EHR) based Clinical Decision Support (CDS) in developing countries like India

Electronic health records (EHRs), an integrated approach is gaining importance not only within healthcare organizations and with their related stakeholders but also with the clinical research studies. EHR-based clinical decision support (CDS) systems in clinical studies have been proven successful in many clinical studies. The World Health Organization has emphasised the necessity to revolutionise the healthcare system in all levels, from primary health care and community service to health care research and this started with the implementation of EHR services extensively in various health care systems. Further, American and European healthcare systems are keen in improving EHR-based measurements to enable interoperability for future integrations of multiple data sources, which in turn would prove beneficial in the global platform for not only to the provider, patient, and other healthcare stakeholders but also for clinical research studies. This paper discusses the EHR in clinical research, the challenges in the EHR, and the need for developing nations to adopt and develop EHR.

A modular cloud-based ontology framework for context-aware EHR services

Healthcare providers in a heterogeneous distributed environment depend on many non-functional requirements or cross-cutting concerns that could affect the entire Healthcare Information System (HIS). The implementation of crosscutting concerns could potentially lead to a significant impact on the integrity of Electronic Health Records (EHRs), as well as code quality. Aspect-Oriented Programming (AOP) encapsulates the crosscutting concerns to improve the overall quality of software development by reducing the required code to implement collection modules. In this paper, we propose an AOP-based novel approach to improve the elasticity of cloud-based EHR services. We propose an abstract framework for cloud-based HIS, which provides EHR interoperability through incorporating crosscutting concerns. The proposed framework eliminates the need to change the core code by adding high-level abstractions to complex cloud applications. We implement a prototype of the proposed framework to validate its ability in both separation of concerns and the ability to reuse EHR services.

Service Design for Value Networks: Enabling Value Cocreation Interactions in Healthcare

In the increasingly complex service environment, value is cocreated through webs of interactions between provider networks and customer networks. This is evident in healthcare services, where well-being can be achieved only through the joint efforts of professional healthcare networks and patient networks. Addressing the challenge of creating network-level services, the service design for value networks (SD4VN) method designs services as enablers of many-to-many value cocreating interactions among network actors. By integrating previous research on value networks and service design, SD4VN develops a process and a set of models beyond supporting dyadic (customer–service provider) interactions to understanding the interrelated activities, interactions, and goals of network actors and designing services to support the different actors in reaching their goals with balanced centricity. Following a design science research approach, this paper presents the SD4VN method and reports on a case application of the method used to design the Portuguese national electronic health record service Plataforma de Dados da Saúde (PDS). The case application involved focus groups, in-depth interviews, and participatory design sessions with over 170 participants at different service design stages, showing the importance of designing a balanced, integrated service. The case application also shows how SD4VN can support a wider adoption of the service and improve the health service system.

Early Experiences with Mobile Electronic Health Records Application in a Tertiary Hospital in Korea.

ObjectivesRecent advances in mobile technology have opened up possibilities to provide strongly integrated mobile-based services in healthcare and telemedicine. Although the number of mobile Electronic Health Record (EHR) applications is large and growing, there is a paucity of evidence demonstrating the usage patterns of these mobile applications by healthcare providers. This study aimed to illustrate the deployment process for an integrated mobile EHR application and to analyze usage patterns after provision of the mobile EHR service.MethodsWe developed an integrated mobile application that aimed to enhance the mobility of healthcare providers by improving access to patient- and hospital-related information during their daily medical activities. The study included mobile EHR users who accessed patient healthcare records between May 2013 and May 2014. We performed a data analysis using a web server log file analyzer from the integrated EHR system. Cluster analysis was applied to longitudinal user data based on their application usage pattern.ResultsThe mobile EHR service named M-UMIS has been in service since May 2013. Every healthcare provider in the hospital could access the mobile EHR service and view the medical charts of their patients. The frequency of using services and network packet transmission on the M-UMIS increased gradually during the study period. The most frequently accessed service in the menu was the patient list.ConclusionsA better understanding regarding the adoption of mobile EHR applications by healthcare providers in patient-centered care provides useful information to guide the design and implementation of future applications.

Patients' continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data.

BackgroundOnline access to all or part of their health records is widely demanded by patients and, where provided in form of patient portals, has been substantially used by at least subgroups of patients, particularly those with chronic disease. However, little is reported regarding the longer-term patient use of patient-accessible electronic health record services, which is important in allocating resources. Renal PatientView (RPV) is an established system that gives patients with chronic kidney disease access to live test results and information about their condition and treatment. It is available in most UK renal units with up to 75% of particular patient groups registered in some centers. We have analyzed patient use out to 4 years and investigated factors associated with more persistent use.ObjectiveOur aim was to investigate RPV use by patients over time from initial registration in order to understand which patients choose to access RPV and the endurance of its appeal for different patient groups.MethodsWe analyzed an anonymized extract of the database underlying RPV containing information on patient registration and events including patient access and the arrival of new blood test results or letters that patients might wish to view.ResultsAt the time of the extract, there were 11,352 patients registered on RPV for 0-42 months (median 17). More than half of registrants became persistent users, logging in a median of 2.0 times each month over post-registration intervals of up to 42 months (median 18.9). Provision of assistance with first logon was strongly associated with becoming a persistent user, even at 3 years. Logons by persistent users occurred around the time of consultations/tests, strongly suggestive of patient engagement. While indices indicative of greater deprivation were the strongest determinants of non-participation, they had negligible influence on drop-out rates among established users.ConclusionsIn this mature patient portal system, a large proportion of patients made regular use of their online health records over protracted periods. The patterns and timing of use indicate strong patient interest in detailed information such as recent test results and clinic letters. Supporting patients through the first steps of establishing access to their online records is associated with much higher rates of long-term use of RPV and likely would increase use of other electronic health records provided for patients with chronic disease.

Understanding value co-creation in complex services with many actors

Purpose – The purpose of this paper is to explore the concept of value co-creation in complex value networks with many actors. Electronic health records (EHRs) are innovations that warrant deep study to properly introduce such a complex system. Design/methodology/approach – The paper describes a qualitative study based on Grounded Theory to understand value co-creation from multiple actors’ perspectives in a National EHR Service Project: the Portuguese Health Data Platform. Findings – Study results enabled further development of the value co-creation concept in complex environments with multiple actors. More specifically they allowed: operationalizing the value co-creation concept by identifying its factors and outcomes, understanding how value co-creation factors and outcomes are interconnected, and understanding of how value co-creation for each actor depends on his/her own actions and the actions of other actors, in a complex set of interactions and interdependencies. Practical implications – The findings have implications for service managers seeking to understand how actors participating in the network integrate resources and interact to co-create value. The study highlights the need for designing and managing services to co-create value, not only by enabling dyadic interactions between the customer and the service provider, but also by supporting and enabling value co-creation interactions among different actors in the network. Originality/value – This study responds to the need for empirical research on value co-creation in many-to-many contexts and for operationalizing the value co-creation concept.

Developing Interoperable Electronic Health Record Service in China

(1) Second Affiliated Hospital College of Medicine Zhejiang University Hangzhou China; (2) Institute of Medical-care Information Technology Hangzhou China; (3) Hangzhou Normal University Hangzhou China; (4) Chinese Academy of Engineering Beijing China; (5) College of Computer Science and Technology Zhejiang University Hangzhou China; (6) Ministry of Health - EHR Steering Committee Beijing China; (7) Hangzhou State Software Industry Base Co. Ltd Hangzhou China; (8) Sir Run Run Shaw Hospital College of Medicine Zhejiang University Hangzhou China

Information governance in NHS's NPfIT: A case for policy specification

Purpose The National Health Service's (NHS's) National Programme for Information Technology (NPfIT) in the UK with its proposed nation-wide online health record service poses serious technical challenges, especially with regard to access control and patient confidentiality. The complexity of the confidentiality requirements and their constantly evolving nature (due to changes in law, guidelines and ethical consensus) make traditional technologies such as role-based access control (RBAC) unsuitable. Furthermore, a more formal approach is also needed for debating about and communicating on information governance, as natural-language descriptions of security policies are inherently ambiguous and incomplete. Our main goal is to convince the reader of the strong benefits of employing formal policy specification in nation-wide electronic health record (EHR) projects. Approach Many difficulties could be alleviated by specifying the requirements in a formal authorisation policy language such as Cassandra. The language is unambiguous, declarative and machine-enforceable, and is based on distributed constrained Datalog. Cassandra is interpreted within a distributed Trust Management environment, where digital credentials are used for establishing mutual trust between strangers. Results To demonstrate how policy specification can be applied to NPfIT, we translate a fragment of natural-language NHS specification into formal Cassandra rules. In particular, we present policy rules pertaining to the management of Clinician Sealed Envelopes, the mechanism by which clinical patient data can be concealed in the nation-wide EHR service. Our case study exposes ambiguities and incompletenesses in the informal NHS documents. Conclusions We strongly recommend the use of trust management and policy specification technology for the implementation of nation-wide EHR infrastructures. Formal policies can be used for automatically enforcing confidentiality requirements, but also for specification and communication purposes. Formalising the requirements also reveals ambiguities and missing details in the currently used informal specification documents.

An infrastructure for Integrated Electronic Health Record services: the role of XML (Extensible Markup Language).

BackgroundThe sharing of information resources is generally accepted as the key to substantial improvements in productivity and better quality of care. In addition, due to the greater mobility of the population, national and international healthcare networks are increasingly used to facilitate the sharing of healthcare-related information among the various actors of the field. In the context of HYGEIAnet, the regional health telematics network of Crete, an Integrated Electronic Health Record environment has been developed to provide integrated access to online clinical information, accessible throughout the island.ObjectivesTo make available comprehensive medical information about a patient by means of incorporating all the distributed and heterogeneous health record segments into an Integrated Electronic Health Record that can be viewed on-line through a unified user interface and visualization environment.MethodsThe technological approach for implementing this Integrated Electronic Health Record environment is based on the HYGEIAnet Reference Architecture, which provides the necessary framework for the reuse of services, components, and interfaces. Seamless presentation of information is achieved by means of the Extensible Markup Language (XML), while its underlying capabilities allow for dynamic navigation according to personalized end-user preferences and authorities.ResultsThe Integrated Electronic Health Record environment developed in HYGEIAnet provides the basis for consistent and authenticated access to primary information over the Internet in order to support decision-making. Primary information is always kept at the place where it has been produced, and is maintained by the most appropriate clinical information system, contrasting traditional store and forward techniques, or centralized clinical data repositories.ConclusionsSince documents are much more easily accessible rather than data inside a database, Extensible Markup Language has the potential of becoming a very cheap technology provided, of course, that the underlying Healthcare Information Infrastructure exists. XML can be introduced incrementally and its implementation is completely transparent to the end user.