Health Record Access Research Articles

PatCen: A blockchain-based patient-centric mechanism for the granular access control of infectious disease-related test records.

The recent global outbreaks of infectious diseases such as COVID-19, yellow fever, and Ebola have highlighted the critical need for robust health data management systems that can rapidly adapt to and mitigate public health emergencies. In contrast to traditional systems, this study introduces an innovative blockchain-based Electronic Health Record (EHR) access control mechanism that effectively safeguards patient data integrity and privacy. The proposed approach uniquely integrates granular data access control mechanism within a blockchain framework, ensuring that patient data is only accessible to explicitly authorized users and thereby enhancing patient consent and privacy. This system addresses key challenges in healthcare data management, including preventing unauthorized access and overcoming the inefficiencies inherent in traditional access mechanisms. Since the latency is a sensitive factor in healthcare data management, the simulations of the proposed model reveal substantial improvements over existing benchmarks in terms of reduced computing overhead, increased throughput, minimized latency, and strengthened overall security. By demonstrating these advantages, the study contributes significantly to the evolution of health data management, offering a scalable, secure solution that prioritizes patient autonomy and privacy in an increasingly digital healthcare landscape.

Survey paper on Secured Data Retrieval from a distributed database using custom blockchain and Role Base Access Control.

These days, there has been a paradigm shift in the upkeep of Electronic Medical Records (EMRs) in mobile cloud environments. This involves integrating cloud computing with mobile devices to facilitate the transmission of healthcare information between patients and healthcare professionals. With the help of this innovative approach, healthcare may be provided with a high degree of flexibility, minimal overhead costs, and electronic health record access. This new strategy also raises concerns about the security of the networks that enable e-health systems and the privacy of patient data. Finding a solution to efficiently distribute EMRs across mobile users in mobile cloud settings while also upholding the highest security standards is a challenging task. In this paper, explored two different distributed blockchain and cloud frameworks for EMR sharing that combine blockchain technology with a mobile cloud's Decentralised Interplanetary File System (DIFS). Based on the empirical findings, it seems that the idea provides a practical way to protect critical patient data from possible threats and guarantee the dependability of data transfers on mobile clouds. There are notable performance improvements in areas like data privacy protections, minimal network latency, maximum security levels, and lightweight access control when comparing the results of this security analysis and performance assessment to those of earlier data sharing models.

Closing the Gap: Foster Parents' Lived Experiences and Recommendations for Interdisciplinary Health-Care Providers.

Purpose: This study explored barriers and facilitators to utilizing health-care services for foster youth, from the perspective of foster parents. Background: There are nearly 437,283 youths in the United States foster care system. Youths living in locations that are different from their familial home situations have a significantly higher occurrence of physical and mental health illnesses than children who remain in their familial homes, increasing risk for homelessness, substance use and abuse, chronic long-term illnesses, and incarceration, thus placing additional burden on the health-care system. Design and Methods: This study utilized a qualitative descriptive design with purposive sampling, with video focus groups to explore 15 foster parents' experiences in accessing health-care services for foster youth. Results: Barriers and facilitators to accessing health care and care coordination were identified, including logistics, transportation, electronic health record access, location of health care, and the impact of the social worker. Practice Implications: Nurses are well-positioned to aid in closing gaps in care for foster youth. Conclusions: These experiences provide important insights and implications for health-care providers and for future research and policy development.

Comparing South Dakota Pharmacist Perspectives of Pharmacy Services in Rural versus Urban settings

BackgroundAccess to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role. ObjectiveThe objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota. MethodsThis qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers. ResultsParticipants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators. ConclusionsNext steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

The Premier Medical Education Model: Improving Preceptor Recruitment in Underserved Areas.

Building on research highlighting the success of tribal, rural, and underserved clerkships to increase students' intention to practice family medicine in these areas, we explored the perspectives of prospective precepting physicians and administrators to develop an optimal structure to facilitate recruitment of external preceptors. We conducted semistructured interviews with family physicians (N=14) and health system administrators (N=14) working in tribal, rural, and underserved areas. Discussions were recorded, transcribed verbatim, and coded independently by two researchers. Applying rapid assessment qualitative research methods, we used a framework method to identify emergent themes that were applied to improve the recruitment of external preceptors. Physicians identified key facilitating factors and barriers to serving as a preceptor, which paralleled those common within the existing literature. However, administrators were motivated to serve as a precepting site to increase the potential of recruiting future physicians. We developed the Premier Medical Education Hub model to align these different but compatible interests with the goal to increase preceptor participation. In this model, each host site dedicates staff and adopts standardized procedures to manage rotations, hosts at least five students annually, provides housing, has procedures to facilitate electronic health record access, and offers student immersion experiences. As practice ownership shifts from physician-owned to health system ownership, administrators become the gatekeepers for prospective preceptors. Our findings demonstrate that integrating the compatible interests between physicians and administrators allows for the creation of a synergistic model that facilitates preceptor recruitment.

Enhancing availability of services to control hypertension through a team-based care approach that includes pharmacists

BackgroundPrimary care physician (PCP) shortages are expected to increase. The Michigan Medicine Hypertension Pharmacists’ Program uses a team-based care (TBC) approach to redistribute some patient care responsibilities from PCPs to pharmacists for patients with diagnosed hypertension. ObjectiveThis evaluation analyzed whether the Michigan Medicine Hypertension Pharmacists’ Program increased the availability of hypertension management services and described facilitators that addressed barriers to program sustainability and replicability. MethodsWe conducted a retrospective observational study that used a mixed methods approach. We examined the availability of hypertension management services using the number of pharmacists’ referrals of patients to other services and the number of PCP appointments. We analyzed qualitative interviews with program staff and site-level quantitative data to examine the program’s impact on the availability of services, the impact of TBC that engaged pharmacists, and program barriers and facilitators. ResultsPatients who visited a pharmacist had fewer PCP visits over 3- and 6-month periods compared to a matched comparison group that did not see a pharmacist and were 1.35 times more likely to receive a referral to a specialist within a 3-month period. Support from leaders and physicians, shared electronic health record access, and financial backing emerged as leading factors for program sustainability and replicability. ConclusionAdding pharmacists to the care team reduced the number of PCP appointments per patient while increasing the availability of hypertension management services; this may in turn improve PCPs’ availability. Similar models may be sustainable and replicable by relying on organizational buy-in, accessible infrastructure, and financing.

1369. Effect of COVID-19 on Antibiotic Consumption: An Analysis of the COVID-19 Community Research Partnership

Abstract Background The COVID-19 Community Research Partnership (CCRP) is a multisite healthcare system-based study of the COVID pandemic. Community residents in this study provided consent for electronic health record (EHR) access allowing for analysis of antibiotic prescribing. Methods We conducted a retrospective, self-controlled cohort study to determine antibiotic consumption in the CCRP pre-COVID (Jan 2018 - Dec 2019) and post-COVID (Jan 2020 - Jan 2022). Participants were ≥18 years with an EHR record in the pre-COVID period. The primary outcome was the number of antibiotic prescriptions (AP) per 1000 patient care encounters in each time period. Secondary outcomes included the AP location of care, analysis of antibiotic classes, and COVID attributable antibiotic consumption, defined as an AP written ≤14 days before or after an EHR documented or self-reported positive SARS-CoV-2 test or COVID diagnosis. Results 34,234 participants were included representing 2,775,711 encounters. Median age was 53 years with 70% female and 88% white. 41% lived in a rural or suburban area. There were 26,121 APs among 25,433 participants. Mean rate of AP per 1000 encounters was 12.1 and 7.6 pre vs post-COVID (p< 0.001). A decline in AP occurred at onset of the pandemic persisting through the post-COVID period (Fig 1). The prescribing rate for all antibiotics, except linezolid, decreased during the pandemic (p< 0.001, Fig 2). The largest declines were seen with antibiotics typically prescribed for respiratory illnesses. The decline in antibiotic consumption was driven by outpatient encounters (Fig 3). 6,341 participants were diagnosed with COVID and 333 APs were COVID attributable. These participants were more likely to receive a macrolide (45% vs. 22%, p< 0.001), live in a rural area (31% vs. 20%, p< 0.001), and receive care in an emergency department (12% vs. 6.1%, p< 0.001). Figure 1. Antibiotic Prescriptions During The Study Time Period Figure 2. Analysis Of Antibiotic Classes Figure 3. Location of Antibiotic Prescribing Conclusion The COVID pandemic was associated with a broad decline in antibiotic consumption. These results may be due to declines in other respiratory viruses, anchoring bias for COVID during the pandemic, improved antibiotic stewardship practices, or social isolation. Antibiotics for respiratory illnesses declined the most, suggesting this may be a target for outpatient stewardship efforts. Disclosures All Authors: No reported disclosures

331 Implementation of Integrated Electronic Health Record Access for Out-of-Hospital Clinicians

331 Implementation of Integrated Electronic Health Record Access for Out-of-Hospital Clinicians

Effectiveness of Screen-Based Simulation as a Strategy to Improve Nurse Practitioner Students' Access to Electronic Health Records in Clinical Education.

Learning to use electronic health records is essential for family nurse practitioner students to inform practice and clinical decision-making. Limited access to electronic health records during clinical training can lead to suboptimal use. Academic programs often rely on healthcare organizations to provide opportunities for students to learn electronic health record skills. However, clinical experiences are highly individualized, and students may not have access to electronic health records. Alternatives are needed to develop this critical competency. This study compared self-reported ratings regarding comfort and access to electronic health record documentation between students who participated in screen-based simulation and students who completed traditional clinical experiences with a preceptor during the last 70 hours of clinical training in one family nurse practitioner program. There was a significant difference in electronic health record access between students who participated in simulated versus traditional clinical experiences (P = .002). There were no significant differences in ratings of comfort using electronic health records between groups. Both groups reported limited access to electronic health records in the first 500 hours of clinical experience. However, students who participated in screen-based simulation reported a quarter-fold increase in electronic health record access during their last 70 hours of clinical training.

A Study of Healthcare Team Communication Networks using Visual Analytics.

Cooperation among teams or individuals of healthcare professionals (HCPs) is one of the crucial factors towards patients' survival outcome. However, it is challenging to uncover and understand such factors in the complex Multiteam System (MTS) communication networks representing daily HCP cooperation. In this paper, we present a study on MTS communication networks constructed with real-world cancer patients' Electronic Health Record (EHR) access logs. We adopt a visual analytics workflow to extract associations between semantic characteristics of MTS communication networks and the patients' survival outcomes. The workflow consists of a neural network learning phase to classify the data based on the chosen input and output attributes, a dimensionality reduction and optimization phase to produce a simplified set of results for examination, and finally an interpreting phase conducted by the user through an interactive visualization interface. We provide the insights found using this workflow with two case studies and an expert interview.

Implementing Democratized Patient Health Record Access Through Distributed Ledger Technologies and Token Economics

This session delves into a real use case that led to the development of an existing production quality consumer app currently available on both Apple App Store and Google Play. The discussion focuses on practical considerations, implementation decisions and the nuances of the token economics that were the foundation of this solution.

Blockchain-based framework for secure and efficient exchange of electronic medical records on mobile cloud environments

The maintenance of Electronic Medical Records (EMRs) on mobile cloud platforms, in which mobile devices are incorporated with cloud computing to ease healthcare information exchange between healthcare providers and patients, has become a paradigm shift in latest days. This cutting-edge strategy makes it possible to provide medical care at a low overhead expense, with a high level of flexibility, and with electronic health record access. Furthermore, this new approach also expresses concern over the confidentiality of patient data and the safety of the networks that support e-health systems. It is a tough problem to figure out a way to effectively share EMRs amongst mobile users while also maintaining maximum security measures in mobile cloud environments. In this research, a novel framework is presented for the sharing of EMRs that integrates blockchain technology and the decentralized Interplanetary File System (DIFS) on a mobile cloud. The empirical results suggest that the concept offers a useful method for ensuring the reliability of data transfers on mobile clouds, while also preserving important patient data from any potential dangers that may arise. Comparing the results of this performance assessment and security analysis to those of previously implemented data sharing models reveals significant performance enhancements in areas such as lightweight access control method, minimal network latency, maximum security levels, and data privacy protections.

Clinical Pharmacy Services Enhanced by Electronic Health Record (EHR) Access: An Innovation Narrative.

Patient care in the community pharmacy setting is often hindered due to limited access to adequate patient health information (PHI). Various studies suggest that lack of access to PHI is a main reason for delay in pharmaceutical care, medication dispensing errors, and lacking interprofessional relationships between prescribers and pharmacists. Literature has shown that interprofessional collaboration and improved access to PHI can improve transitions of care and communication for pharmacists, but literature is sparse on implementation of electronic health record (HER) access within independent community pharmacies. This observational study follows implementation of HER access into a rural community pharmacy to enhance common clinical services carried out by pharmacy staff. Metrics include number of enhanced consultations by pharmacy staff, type of consultations provided, potential reimbursement, decreased need to follow up with other providers, potential for decreased time to treatment or refills, and aspects of EHR most utilized during search. Two-hundred sixty three patients' profiles were assessed, with 164 (62.4%) deemed appropriate for EHR access and searching. Most interventions made were related to cardiovascular, endocrinologic, neuropsychiatric, and COVID-19 therapy medications. EHR access in community pharmacy has the potential to improve both the quality and availability of clinical patient interventions through enhanced knowledge of PHI.

Blockchain-based medical health record access control scheme with efficient protection mechanism and patient control.

The patient's medical health record (PMHR) has always provided a large amount of research data to medical institutions and pharmaceutical companies, etc., and has contributed to the development in medical research. However, such PMHR data contains the patient's personal privacy and should be shared under the control of the patients, not the hospital where this data is acquired. In order to protect the privacy of PMHR data while realizing efficient data sharing, this paper proposes a blockchain-based sharing and protection scheme. In this solution, the PMHR data are encrypted and stored in a cloud server, which is equipped with an access control scheme implemented as a smart contract on a blockchain. Different from previous works, in order to ensure efficient access and reduce the workload of patients, the types of users who can apply for access are limited to hospitals and pharmaceutical companies. In order to resist the potential Man-in-the-middle (MITM) attack, we have introduced an improved proxy re-encryption scheme to ensure the secrecy of PMHR data while reducing the computational complexity. The whole system is implemented using Solidity and tested on 10 nodes for function verification. Experimental result shows that the proposed system is more efficient than previous systems. Security under the MITM attack is also ensured by security analysis.

Patients’ use of smartphone apps for health record access in 2019: A cross-sectional study

IntroductionThe 21st Century Cures Act has expanded patients’ access to portals through smartphone applications (apps). To date, the prevalence of patient portal smartphone apps use is unclear, especially on a national scale. MethodsUsing the 2019 Health Information National Trends Survey, we assessed factors associated with patient portal adopters accessing their records through a smartphone app. Multivariable logistic regression models were conducted and we reported results using predicted probability. ResultsAcross a weighted sample of 75,324,288 respondents, 39 % reported using a smartphone app to access their health records. Adults with smartphone-only internet (40.0 %; 95 % CI: 35.4–33.3) were more likely to use a smartphone app compared to adults with home internet access (30.6 %; 95 % CI: 27.9–44.7). ConclusionsOptimizing the implementation and delivery of patient portal content via smartphone apps may improve their reach to patients.

Facilitating Health Information Exchange to Improve Health Outcomes for School-Aged Children: School Nurse Electronic Health Record Access.

School-aged children with chronic conditions require care coordination for health needs at school. Access to the student's accurate, real-time medical information is essential for school nurses to maximize their care of students. We aim to analyze school nurse access to medical records in a hospital-based electronic health record (EHR) and the effect on patient outcomes. We hypothesized that EHR access would decrease emergency department (ED) visits and inpatient hospitalizations. This retrospective secondary data analysis was conducted using EHR data 6 months pre- and post-school nurse access to students' hospital-based EHR. The main outcome measures were the ED visits and inpatient hospitalizations. For the sample of 336 students in the study, there was a 34% decrease in ED visits from 190 visits before access to 126 ED visits after access (p <0.01). Inpatient hospitalizations decreased by 44% from 176 before access to 99 after access (p <0.001). The incident rate of ED visits decreased (IRR: 0.66; 95% CI: 0.53-0.83; p = 0.00035), and hospitalizations decreased (IRR: 0.56; 95% CI: 0.44-0.72; p <0.0001) from pre to post access. These findings suggest school nurse access to medical records is a positive factor in improving school-aged patient outcomes. School nurse access to medical records through the hospital-based EHR may be a factor to improve patient outcomes by utilizing health information technology for more efficient and effective communication and care coordination for school-aged children with chronic medical conditions.

A Log Analysis Exploring the Predictors of Electronic Health Record Access by Clinicians for Consumers Aged ≥65 Who Present to the Emergency Department.

Electronic health records are widely implemented, yet little is understood around adoption and use in the ED setting. Older patients (≥65) are a cohort likely to benefit from use. The primary outcome (MHR access) was explored using logistic regression of 9 independent variables. 28.33% of patients had their MHR accessed within 3 days of presenting. Access is more likely when patients arrive via urgent ambulance and/or are triaged as critical.

Characterization of Electronic Health Record Use Outside Scheduled Clinic Hours Among Primary Care Pediatricians: Retrospective Descriptive Task Analysis of Electronic Health Record Access Log Data.

BackgroundMany of the benefits of electronic health records (EHRs) have not been achieved at expected levels because of a variety of unintended negative consequences such as documentation burden. Previous studies have characterized EHR use during and outside work hours, with many reporting that physicians spend considerable time on documentation-related tasks. These studies characterized EHR use during and outside work hours using clock time versus actual physician clinic schedules to define the outside work time.ObjectiveThis study aimed to characterize EHR work outside scheduled clinic hours among primary care pediatricians using a retrospective descriptive task analysis of EHR access log data and actual physician clinic schedules to define work time.MethodsWe conducted a retrospective, exploratory, descriptive task analysis of EHR access log data from primary care pediatricians in September 2019 at a large Midwestern pediatric health center to quantify and identify actions completed outside scheduled clinic hours. Mixed-effects statistical modeling was used to investigate the effects of age, sex, clinical full-time equivalent status, and EHR work during scheduled clinic hours on the use of EHRs outside scheduled clinic hours.ResultsPrimary care pediatricians (n=56) in this study generated 1,523,872 access log data points (across 1069 physician workdays) and spent an average of 4.4 (SD 2.0) hours and 0.8 (SD 0.8) hours per physician per workday engaged in EHRs during and outside scheduled clinic hours, respectively. Approximately three-quarters of the time working in EHR during or outside scheduled clinic hours was spent reviewing data and reports. Mixed-effects regression revealed no associations of age, sex, or clinical full-time equivalent status with EHR use during or outside scheduled clinic hours.ConclusionsFor every hour primary care pediatricians spent engaged with the EHR during scheduled clinic hours, they spent approximately 10 minutes interacting with the EHR outside scheduled clinic hours. Most of their time (during and outside scheduled clinic hours) was spent reviewing data, records, and other information in EHR.

Behavioral Health Professionals' Perceptions on Patient-Controlled Granular Information Sharing (Part 1): Focus Group Study.

BackgroundPatient-controlled granular information sharing (PC-GIS) allows a patient to select specific health information “granules,” such as diagnoses and medications; choose with whom the information is shared; and decide how the information can be used. Previous studies suggest that health professionals have mixed or concerned opinions about the process and impact of PC-GIS for care and research. Further understanding of behavioral health professionals’ views on PC-GIS are needed for successful implementation and use of this technology.ObjectiveThe aim of this study was to evaluate changes in health professionals’ opinions on PC-GIS before and after a demonstrative case study.MethodsFour focus groups were conducted at two integrated health care facilities: one serious mental illness facility and one general behavioral health facility. A total of 28 participants were given access to outcomes of a previous study where patients had control over medical record sharing. Participants were surveyed before and after focus groups on their views about PC-GIS. Thematic analysis of focus group output was paired with descriptive statistics and exploratory factor analysis of surveys.ResultsBehavioral health professionals showed a significant opinion shift toward concern after the focus group intervention, specifically on the topics of patient understanding (P=.001), authorized electronic health record access (P=.03), patient-professional relationship (P=.006), patient control acceptance (P<.001), and patient rights (P=.02). Qualitative methodology supported these results. The themes of professional considerations (2234/4025, 55.5% of codes) and necessity of health information (260/766, 33.9%) identified key aspects of PC-GIS concerns.ConclusionsBehavioral health professionals agreed that a trusting patient-professional relationship is integral to the optimal implementation of PC-GIS, but were concerned about the potential negative impacts of PC-GIS on patient safety and quality of care.

The 21st Century Cures Act and Multiuser Electronic Health Record Access: Potential Pitfalls of Information Release.

Although the Office of The National Coordinator for Health Information Technology’s (ONC) Information Blocking Provision in the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multiuser electronic health record (EHR) access and proxy access, concerns on the potential for harm in adolescent care contexts exist. We describe how the provision could erode patients’ (both adolescent and older patients alike) trust and willingness to seek care. The rule’s preventing harm exception does not apply to situations where the patient is a minor and the health care provider wishes to restrict a parent’s or guardian’s access to the minor’s EHI to avoid violating the minor’s confidentiality and potentially harming patient-clinician trust. This may violate previously developed government principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate “shadow charting” will be burdensome (and prohibitive) for health care providers. Under the privacy exception, patients have the opportunity to request information to not be shared; however, depending on institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot “improperly encourage or induce a patient’s request to block information.” Fearing being found in violation of the information blocking provisions, providers may feel that they are unable to guide patients navigating the release of their EHI in the multiuser or proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations that care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multiuser or proxy access situations.