Electronic Healthcare Services Research Articles

Digitalization of services in the field of patients’ rights protection: current state and prospects for the development of legislation

This scientific article is devoted to the current problems of digital transformation in the field of health care and the introduction of electronic medical services. The main directions of introduction of the digitalization process in the sphere of medicines circulation in Ukraine are revealed, the attention is focused on the positive and negative moments of digitalization in the sphere of medicines circulation in Ukraine. Possible areas for improving digitalization in the field of circulation of medicines in Ukraine are identified, as well as the need to improve the legal regulation of digitalization in the field of circulation of medicines in Ukraine in order to protect the rights and interests of patients in the field of medicines. The article analyses the current state of legal regulation of digitalisation in the healthcare sector of Ukraine and the readiness to provide quality electronic healthcare services to patients. The authors have identified the need to adopt and amend regulations that would regulate the development of the electronic healthcare system, in particular, the introduction of an electronic public health system; electronic document management in the field of healthcare; implementation of measures to ensure the safety of medicines and the creation of an electronic prescription; expansion of the functions of the electronic system of state registers; automation of medical services; and legalisation of medical cannabis.
 The article examines the problems of legalisation of cannabis for medical purposes in Ukraine. International legal acts and standards in the field of narcotic drugs and psychotropic substances are analysed. The authors review national legislative acts regulating the production and trafficking of narcotic drugs, psychotropic substances and precursors.
 The article examines the German experience of legal support for patients’ access to the necessary medical cannabis treatment for various diseases and post-traumatic stress disorders. The article identifies the specifics of legal regulation of medical cannabis treatment services. The authors outline two types of medical cannabis treatment services - general and special, which differ in procedural features.

TO THE ISSUE OF DIGITIZATION OF THE SERVICE SECTOR IN UKRAINE

It is shown that information technologies create conditions for penetration and active interaction of virtual and physical space, that is, they create a digital cyber-physical space. It has been determined that universal coverage of health services is impossible without the support of eHealth. At the same time, the issue of minimizing potential risks by improving security and privacy functions will require special attention. This approach encompasses system quality, positive information dissemination, and risk mitigation to build user confidence and encourage widespread adoption of eHealth programs. The purpose of the article is to analyze and formulate proposals for the active involvement of information technologies and digital services in the field of health care in Ukraine. A meaningful analysis of the current state and development trends of the electronic healthcare system, as the basis of the digital healthcare ecosystem of Ukraine, was conducted. It creates key services and contains basic data about the health of Ukrainians. A questionnaire survey of respondents was conducted regarding the attitude and willingness of Ukrainians to use electronic health care services in terms of their age distribution and their distribution by gender, according to the time spent on communicating on the Internet and experience using the e-Healthy system, as well as the level of awareness of e-Health. On the basis of processing the results of the survey, as well as interviewing industry experts, information models were developed regarding the level of trust and readiness to use electronic healthcare services. It was determined that a key task for Ukraine in the context of promoting e-Healthy systems is to inform the population about the content, specifics and benefits of its use. Another challenge for the state is the formation of public trust in such services. Keywords: information technologies, digitalization, service sector, digital medicine, digital marketing

REGULATION OF DIGITAL HEALTHCARE SERVICES – (NOT) COVERED UNDER THE DIGITAL SERVICES ACT?

The regulation of digital services is currently experiencing significant growth, primarily due to the adoption of new legal regulation at the European Union level, specifically the Digital Services Act. Digital services play a pivotal role in a country's economy by facilitating cross-border trade and enabling entrepreneurs to reach a vast user base, often comprising consumers. Despite their advantages, these services also entail substantial risks, particularly in relation to their widespread and more challenging-to-regulate usage. Alongside their positive impact, they also contribute significantly to the dissemination of illegal and harmful information. In recent years, there has been a notable development and utilization of new electronic information systems within the healthcare sector, accompanied by electronic healthcare services. This connection is not limited to the Covid-19 pandemic but is also a result of the dynamic evolution of information and communication technologies and their potential in healthcare provision. In this paper, the author analyzes the research question regarding which digital healthcare services in the Slovak Republic fall within the scope of the new European legislation. The author examined European regulations, focusing on the types of electronic healthcare services existing in Slovakia. By synthesizing and applying available information and rules to selected electronic healthcare services, the study concludes that the Digital Services Act has only a limited impact on the functioning of these selected digital healthcare services.

An Overview of the Evolution and Impact of Chatbots in Modern Healthcare Services

Over the past few decades, healthcare sector has developed along parallel paths with trendy technology. Modern practices of artificial intelligence strategies have led to improved diagnosis, the development of effective treatments, telemedicine, and the development of patient monitoring devices. Many applications have emerged that help doctors and healthcare workers, most notably Chatbot. It is a program that utilises artificial intelligence techniques to conduct conversations in real-time. This program is able to simulate that you are a natural person writing or talking to another Internet user, which is the application. This article discusses the matter of Chatbot technology in developing electronic healthcare services and helping patients communicate electronically to obtain information that supports them in improving their health condition.

A comprehensive systematic and bibliometric review of the IoT-based healthcare systems.

In the healthcare sector, the growth in technology has had a huge effect. Besides, when introduced to the world of healthcare, the Internet of Things (IoT) will simplify the transition by helping physicians closely track their patients, allowing rapid recovery. Aged patients/people should be intensively checked, and their loved ones must be aware of their wellbeing periodically. Therefore, using IoT in healthcare will simplify the lives of physicians and patients alike. Hence, this study explored a comprehensive review of intelligent IoT-based embedded healthcare systems. The papers around intelligent IoT-based healthcare systems printed until Dec-2022 are studied, and some research lines are suggested for the upcoming researchers. Thus, this study's innovation will apply healthcare systems based on IoT to include certain strategies for the future deployment of new generations of IoT-based health technology. The findings revealed that IoT is beneficial for governments to strengthen society's health and economic relations. Besides, owing to novel functional principles, IoT needs modern safety infrastructure. This study is helpful for prevalent and useful electronic healthcare services, health experts, and clinicians.

Password-based authentication and the experiences of end users

Passwords are used majorly for end-user authentication in information and communication technology (ICT) systems due to its perceived ease of use. The use for end-user authentication extends through mobile, computers and network-based products and services. But with the attendant issues relating to password hacks, leakages, and theft largely due to weak, reuse and poor password habits of end-users, the call for passwordless authentication as alternative intensifies. All the same, there are missing knowledge of whether these password-based experiences are associated with societal economic status, educational qualification of citizens, their age and gender, technological advancements, and depth of penetration. In line with the above, understanding the experience of end-users in developing economy to ascertain their password-based experience has become of interest to the researchers. This paper aims at measuring the experience of staff and students in University communities within southeastern Nigeria on password-based authentication systems. These communities have population whose age brackets are majorly within the ages of 16 and 60 years; have people with requisite educational qualifications ranging from Diploma to Doctorate degrees and constitutes good number of ICT tools consumers. The survey had 291 respondents, and collected data about age, educational qualifications, and gender from these respondents. It also collected information about their password experience in social media network, online shopping, electronic health care services, and internet banking. Our analysis using SPSS and report by means of descriptive statistics, frequency distribution, and Chi-Square tests showed that account compromise in the geographical area is not common with the respondents reporting good experience with passwords usage. Furthermore, this experience is not in any way related to their age (under 60), and educational qualification. Our experiment did not measure the entropy of end-users' passwords, their password hygiene culture and so cannot relate this experience with the strengths of their passwords nor that of their password hygiene culture. The outcome and recommendations of this research will help inform policy and research direction towards password hygiene culture, management, and the potentials or otherwise of passwordless authentication systems in developing economies.

Enhanced Cyber Attack Detection Process for Internet of Health Things (IoHT) Devices Using Deep Neural Network

Internet of Health Things plays a vital role in day-to-day life by providing electronic healthcare services and has the capacity to increase the quality of patient care. Internet of Health Things (IoHT) devices and applications have been growing rapidly in recent years, becoming extensively vulnerable to cyber-attacks since the devices are small and heterogeneous. In addition, it is doubly significant when IoHT involves devices used in healthcare domain. Consequently, it is essential to develop a resilient cyber-attack detection system in the Internet of Health Things environment for mitigating the security risks and preventing Internet of Health Things devices from becoming exposed to cyber-attacks. Artificial intelligence plays a primary role in anomaly detection. In this paper, a deep neural network-based cyber-attack detection system is built by employing artificial intelligence on latest ECU-IoHT dataset to uncover cyber-attacks in Internet of Health Things environment. The proposed deep neural network system achieves average higher performance accuracy of 99.85%, an average area under receiver operator characteristic curve 0.99 and the false positive rate is 0.01. It is evident from the experimental result that the proposed system attains higher detection rate than the existing methods.

Integrity and Privacy-Aware, Patient-Centric Health Record Access Control Framework Using a Blockchain

Blockchains are gaining traction as secure and reliable platforms for data sharing in fields such as banking, supply chain management, food production, energy, the Internet, and medical services. Furthermore, when decentralized, a blockchain can be regarded as an immutable ledger storing data entries. Moreover, this modern technology was designed to disrupt various data-driven industries, including the healthcare industry. While electronic healthcare services have enabled more straightforward and accessible treatment, patient privacy has become vulnerable to external and internal attacks by healthcare personnel. Therefore, we aimed to design a framework to control patient health records that ensures the patient can provide the necessary permissions to those who access his/her health records. This framework will record all activities via blockchain and usage control. Through this framework, we aim to create a user-centric and privacy-aware experience. A literature review and experiments have been performed to select an optimized and placable blockchain operating system. In addition, performance analysis showed that the OS and smart contracts work at an acceptable speed.

The usability testing of the integrated electronic healthcare services for diabetes mellitus patients during the pandemic in Indonesia.

Diabetes mellitus is a degenerative disease that obliges patients to take continuous healthcare services. During a pandemic situation, all access to healthcare facilities becomes limited. A web-based integrated electronic-healthcare system (IeHS) study was used to overcome this problem. This study aimed to describe patients' ability to access and understand this web-based application. An observational study using a web-based IeHS took place in Muara Tebo, Indonesia, in 2021. A total of 82 outpatients with diabetes mellitus participated in this study. These patients belonged to local community-based diabetes mellitus. Only adult patients accustomed to using smartphones were invited to participate in this study. All participants were taught to access the web-based application through video recordings. They were asked to fill out the form regarding their understanding of the web-based integrated e-healthcare application. This form was sent online. From the calculation of the usability scale, the results show that patients have not been able to take advantage of this application in life (the system usability scale (SUS) score 63.38). There is no significant difference between patients' characteristics and the SUS score. Participants' condition in this study reflects the general state of outpatients. The ability of these participants to access an internet-based application was related to their education level. This condition becomes a challenge for policymakers to improve local human resources to increase their health literacy.

Adopting electronic healthcare services during COVID-19 and the nations responding: evidence from Jordan

This research aims to examine the national responding of healthcare services and the existing initiatives among adoption of electronic service during the COVID-19 in Jordan. The study model is extending to the theory of acceptance technology and use, which includes effort expectancy, performance expectancy, and facilitating position factors. A quantitative approach survey questionnaire was conducted towards employees working in private hospitals in Jordan. A total of 315 valid and completed responses were retrieved. The sample was randomly selected to ensure fair representation of the population society. The conceptual model of this research was empirically examined using hierarchical regression. The results showed that all independent predictors conceptualised in the model were significant predictors with 80% of the variance in the adoption of electronic healthcare. The study provides some new findings that would help in understanding the role of technology over the emerging situations and crisis particularly in the COVID-19 pandemic.

On the Design of Secured and Reliable Dynamic Access Control Scheme of Patient E-Healthcare Records in Cloud Environment.

Traditional healthcare services have changed into modern ones in which doctors can diagnose patients from a distance. All stakeholders, including patients, ward boy, life insurance agents, physicians, and others, have easy access to patients' medical records due to cloud computing. The cloud's services are very cost-effective and scalable, and provide various mobile access options for a patient's electronic health records (EHRs). EHR privacy and security are critical concerns despite the many benefits of the cloud. Patient health information is extremely sensitive and important, and sending it over an unencrypted wireless media raises a number of security hazards. This study suggests an innovative and secure access system for cloud-based electronic healthcare services storing patient health records in a third-party cloud service provider. The research considers the remote healthcare requirements for maintaining patient information integrity, confidentiality, and security. There will be fewer attacks on e-healthcare records now that stakeholders will have a safe interface and data on the cloud will not be accessible to them. End-to-end encryption is ensured by using multiple keys generated by the key conclusion function (KCF), and access to cloud services is granted based on a person's identity and the relationship between the parties involved, which protects their personal information that is the methodology used in the proposed scheme. The proposed scheme is best suited for cloud-based e-healthcare services because of its simplicity and robustness. Using different Amazon EC2 hosting options, we examine how well our cloud-based web application service works when the number of requests linearly increases. The performance of our web application service that runs in the cloud is based on how many requests it can handle per second while keeping its response time constant. The proposed secure access scheme for cloud-based web applications was compared to the Ethereum blockchain platform, which uses internet of things (IoT) devices in terms of execution time, throughput, and latency.

Assessing the Adoption of e-Health Technology in a Developing Country: An Extension of the UTAUT Model

Electronic healthcare services are becoming an increasingly essential form of information and communication technology (ICT) that enables the fast and smooth delivery of health care, specifically in countries with scarce resources such as Pakistan. A better understanding of factors contributing to the adoption of electronic health care is needed, yet this remains an under-researched phenomenon. Grounded in the united theory of acceptance and use of technology, this article attempts to fill the gap by proposing and empirically testing the contribution of trust, privacy, task-technology fit, and personal innovativeness of patients’ intentions to adopt electronic health technology. A survey questionnaire was used to collect data from 353 patients in major hospitals in Islamabad, Pakistan. This study used Partial Least Square Structural Equation Modeling for the analysis. Results indicate that the intention to adopt electronic health technology is determined mostly by effort expectancy, social influence, facilitating conditions, task-technology fit, trust, privacy, and personal innovativeness in information technology. The study concludes with several managerial implications and future research directions, which give further opportunities to researchers and practitioners in the field of e-health technology.

Adopting Electronic Healthcare Services during COVID-19 and the Nations Responding: Evidence from Jordan

Adopting Electronic Healthcare Services during COVID-19 and the Nations Responding: Evidence from Jordan

E-Healthcare Services – Actual Usage and Intention to Use among Indian Consumers

The boom in the information technology (IT) has drastically changed the life style of people today. The electronic commerce plays a vital role in digital revolution by transforming the Indian consumer’s buying behaviour, and the usage of smart phones, internet, etc., have radically increased among the Indian consumers. The IT revolution has brought a profound renovation in healthcare services too. The huge health information on internet and various healthcare apps available in market have led to the emergence of Electronic Healthcare Services (e-healthcare services). In most of the developed countries people use e-healthcare services to retrieve any kind of information regarding health. This mainly saves the time and energy of the people. The information with regards to health can be obtained from open sources, healthcare apps such as diet apps, fitness apps etc. Moreover, the mobile health apps such as Practo, Docsapp etc., do provide anytime assistance to the users. Today, due to rapid increase in IT usage for healthcare services by the consumers, it is quite essential to the measure the impact of health information provided by websites and apps to their users. The e-healthcare can be viewed as the future of healthcare which is focused on providing quick, better and affordable services to the customers. Therefore, this study attempts to examine the behavioural intention to use and actual usage of the e-healthcare services. A self-administered questionnaire was distributed among the student community in Manipal, Karnataka, and at most 267 students participated in the survey. This study provides an understanding to the researchers aiming at identifying the factors determining the behavioural intention to use e-healthcare services and actual usage. Further, the study brings out the first order dimensions to measure the second order dimension of perceived value of e-healthcare services.

The development of ethical guidelines for telemedicine in South Africa

Telemedicine has the potential to assist in the provision of healthcare in South Africa (SA). This means of healthcare service provision involves patients, doctors and machines working together, with few constraints imposed by geography, or national or institutional boundaries. Although the practice is largely beneficial, certain legal and ethical challenges arise from the use of electronic healthcare services. Certain ethical challenges are identified as: the changing nature of the traditional doctor-patient relationship; standards of care; quality of care; privacy; confidentiality; data protection; accountability; liability; consent; record-keeping; data storage; and authentication. While various legal, regulatory and governance measures offer potential solutions and remedies for protection, ethical direction may be achieved through statutory bodies set up to promote and foster ethical compliance with normative healthcare standards. Recently, the Health Professions Council of SA (HPCSA) made an attempt to address the ethical issues by publishing a set of telemedicine guidelines. Despite this, issues around the practice of telemedicine remain unresolved. This article seeks to inform the development of a new ethical framework by addressing three distinct and relevant ethical issues: the fiduciary nature of healthcare and the changing nature of the doctor-patient relationship; privacy, confidentiality and the sensitivity of health data; and informed consent. It does so by proposing a broader and more nuanced solution to these ethical obstacles by identifying conceptual and operational difficulties within the existing HPCSA telemedicine guidelines, and advancing suggestions for reform. This speaks to a more highly integrated perspective that is culturally and contextually aware, and which affirms the need to strike a balance between individual rights protection and transformative, ethical, healthcare innovation.

Sähköiset terveyspalvelut osaksi potilaan arkea

Viimeaikaiset tutkimukset osoittavat, että mielenkiinto sähköisiä terveyspalveluja kohtaan on lisääntynyt ja samoin tarve niiden käytön ohjaukseen. Tutkimuksen tarkoituksena on analysoida, millaisen merkityksen erikoissairaanhoidon vastaanotolla asioivat potilaat antavat sähköisille palveluille. Lisäksi he arvioivat sähköisten palvelujen hyödyllisyyttä ja helppokäyttöisyyttä. Tutkimusaineisto koottiin yliopistosairaalan poliklinikoilla asioivilta potilailta tai heidän saattajiltaan keväällä 2017. Kysely koostui Likert-asteikollisesta väittämistä (n=29) ja viidestä taustamuuttujasta. Aineistosta (n=113/150, 75%) analysointiin luku- ja prosenttimäärät sekä rakenneyhtälömallia käyttäen tutkittiin Teknologian hyväksyminen –mallin pohjalta asetetut hypoteesien sopivuus aineistoon. Vastaajat arvioivat sähköisten palvelujen käytön motivoivan seuraamaan omaa terveyttä. He kokivat, että sähköiset palvelut ovat helposti saatavilla ja he haluavat käyttää sähköisiä palveluja terveydentilan seurantaan sekä luottavat sähköisten palvelujen mahdollisuuksiin. Vastaajista puolet oli käyttänyt Internetistä saatavilla olevia terveystestejä, mutta terveystarkastuksen sähköisesti oli tehnyt vain muutama. Kanta-palvelut olivat tuttuja ja käyttökokemuksen lisääntyessä palvelut koettiin mielekkäiksi. Nuoret hallitsivat tietotekniikan käytön, kun taas iäkkäämmät vastaajat epäilevät käyttötaitojaan. Tutkimus osoitti, että palvelujen mielekkyys vaikuttaa merkittävästi niin asennoitumiseen kuin aikomukseen käyttää sähköisiä palveluja.

Edge-Based IoT Medical Record System: Requirements, Recommendations and Conceptual Design

This paper presents a conceptual architecture, design, and recommendation for the IoT Edge-based healthcare management system. The suggested architecture aims at distributing the workload of system performance (electronic healthcare services), including monitoring, diagnosis, prediction, as well as managing and archiving medical data of patients across different points of the system (at the edge and on the cloud). The proposed system design consists of two main subsystems (one for monitoring tasks and another one for medical record management activities). Both subsystems interact with multiple kinds of database systems (SQL and NoSQL). Transformational-based system for data migration is presented as a contribution of this paper. Two styles of transformation compositions are considered in the architectural design of transformation agents.

Developing a ubiquitous health management system with healthy diet control for metabolic syndrome healthcare in Taiwan

Background and ObjectiveSelf-management in healthcare can allow patients managing their health data anytime and everywhere for prevention of chronic diseases. This study established a prototype of ubiquitous health management system (UHMS) with healthy diet control (HDC) for people who need services of metabolic syndrome healthcare in Taiwan. MethodsSystem infrastructure comprises of three portals and a database tier with mutually supportive components to achieve functionality of diet diaries, nutrition guides, and health risk assessments for self-health management. With the diet, nutrition, and personal health database, the design enables the analytical diagrams on the interactive interface to support a mobile application for diet diary, a Web-based platform for health management, and the modules of research and development for medical care. For database integrity, dietary data can be stored at offline mode prior to transformation between mobile device and server site at online mode. ResultsThe UHMS-HDC was developed by open source technology for ubiquitous health management with personalized dietary criteria. The system integrates mobile, internet, and electronic healthcare services with the diet diary functions to manage healthy diet behaviors of users. The virtual patients were involved to simulate the self-health management procedure. The assessment functions were approved by capturing the screen snapshots in the procedure. The proposed system development was capable for practical intervention. ConclusionThis approach details the expandable framework with collaborative components regarding the self-developed UHMS-HDC. The multi-disciplinary applications for self-health management can support the healthcare professionals to reduce medical resources and improve healthcare effects for the patient who requires monitoring personal health condition with diet control. The proposed system can be practiced for intervention in the hospital.

Risk - Cash-flow Evaluation of the E-Health Implementation Project in the Slovak Republic

The aim of this paper is to present a risk-cash flow evaluation of the E-Health/Health-IT implementation project in the Slovak Republic. The paper is focused on the economic modelling in the E-Health environment. The costs of E-Health implementation in Slovakia, as demonstrated by foreign examples and studies, are expected to be overrun by cumulated benefits in medium to long term.The processes in the investment activities are characterized by different alternative cost and/or benefit entries in terms of financial inputs and outputs. Four computer simulations based on the Latin Hypercube sampling method are applied to evaluate potential financial effects of events with a respective likelihood of occurrence. Based on the E-Health cost-benefit analysis (CBA), the probability distributions of the Net Present Value (NPV), as one of the basic indicators of measuring the investment efficiency, will be simulated, calculated and discussed. A successful development and implementation of electronic healthcare services are subject to an effective application of robust investments which cover these activities. The paper proves the idea of a seamless project implementation as a precondition for ensuring the health IT project's sustainability and profitability in the long term.

Patient-centric authorization framework for electronic healthcare services

In modern healthcare environments, a fundamental requirement for achieving continuity of care is the seamless access to distributed patient health records in an integrated and unified manner, directly at the point of care. However, Electronic Health Records (EHRs) contain a significant amount of sensitive information, and allowing data to be accessible at many different sources increases concerns related to patient privacy and data theft. Access control solutions must guarantee that only authorized users have access to such critical records for legitimate purposes, and access control policies from distributed EHR sources must be accurately reflected and enforced accordingly in the integrated EHRs. In this paper, we propose a unified access control scheme that supports patient-centric selective sharing of virtual composite EHRs using different levels of granularity, accommodating data aggregation and privacy protection requirements. We also articulate and address issues and mechanisms on policy anomalies that occur in the composition of discrete access control policies from different data sources.