Shared Electronic Health Record Research Articles

Acceptability of Chinese Medicine Information Sharing in electronic Health Record Sharing System (eHRSS) in Chinese medicine practitioners: A mixed-method study

Background and objectives The Stage Two Development of eHRSS aimed to broaden the scope of sharable data and advance technical capability for sharing of Chinese Medicine (CM) information. This study aims to evaluate the adoption level and perceived difficulties of Chinese medicine practitioners (CMPs) towards EC Connect, and its impact on CM services.Methods All registered or listed CMPs were recruited in study 1. Descriptive analysis included age, gender, socioeconomic status, and past medical history was performed with multiple logistic regression models. In-depth interviews were conducted among EC Connect Users and Healthcare Providers (HCP) who upload information of Chinese Medicine to eHRSS.Results A total of 420 participants were included in this study. The majority of the respondents were in the 31–40 years age group (N = 133, 31.7 %) and practicing in private clinic (N = 311, 74.0 %). Respondents whom agreed that the expansion of sharing scope would be helpful to various stakeholders were 5 times more likely to be interested in joining eHRSS (aOR = 5.01, 95 % CI = 2.73–9.20, p < 0.001). Study 2 found that eHRSS allowed CMPs to share and record medical data, and to access patients’ western medical records while inconsistency of medical systems between Western and Chinese medicine should be considered.Conclusions We found that accessing and sharing medical records was important to CMPs. eHRSS helped to facilitate more accurate association between Western and Chinese medical doctors, while more efforts were needed to increase the acknowledgement among the general public.

A pragmatic randomized clinical trial of multilevel interventions to improve adherence to lung cancer screening (The Larch Study): Study protocol

BackgroundIn real-world settings, low adherence to lung cancer screening (LCS) diminishes population-level benefits of reducing lung cancer mortality. We describe the Larch Study protocol, which tests the effectiveness of two patient-centered interventions (Patient Voices Video and Stepped Reminders) designed to address barriers and improve annual LCS adherence. MethodsThe Larch Study is a pragmatic randomized clinical trial conducted within Kaiser Permanente Washington. Eligible patients (target n = 1606) are aged 50–78 years with an index low-dose CT (LDCT) of the chest with negative or benign findings. With a 2 × 2 factorial-design, patients are individually randomized to 1 of 4 arms: video only, reminders only, both video and reminders, or usual care. The Patient Voices video addresses patient education needs by normalizing LCS, reminding patients when LCS is due, and encouraging social support. Stepped Reminders prompts primary care physicians to order patient's repeat screening LDCT and patients to schedule their scan. Intervention delivery is embedded within routine healthcare, facilitated by shared electronic health record components. Primary outcome is adherence to national LCS clinical guidelines, defined as repeat LDCT within 9–15 months. Patient-reported outcomes are measured via survey (knowledge of LCS, perception of stigma) approximately 8 weeks after index LDCT. Our mixed-methods formative evaluation includes process data, collected during the trial, and interviews with trial participants and stakeholders. DiscussionResults will fill an important scientific gap on multilevel interventions to increase annual LCS adherence and provide opportunities for spread and scale to other healthcare settings.Registration: Trial is registered at clinicaltrials.gov (#NCT05747443).

Impact of coordination mechanisms based on information and communication technologies on cross-level clinical coordination: A scoping review.

Coordination mechanisms based on information and communication technologies (ICTs) are gaining attention, especially since the pandemic, due to their potential to improve communication between health professionals. However, their impact on cross-level clinical coordination remains unclear. The aim is to synthesize the evidence on the impact of ICT-based coordination mechanisms on clinical coordination between primary care and secondary care (SC) doctors and to identify knowledge gaps. A scoping review was conducted by searching for original articles in six electronic databases and a manual search, with no restrictions regarding time, area, or methodology. Titles and abstracts were screened. Full texts of the selected articles were reviewed and analysed to assess the impact of each mechanism, according to the cross-level clinical coordination conceptual framework. Of the 6555 articles identified, 30 met the inclusion criteria. All had been conducted in high-income countries, most (n = 26) evaluated the impact of a single mechanism - asynchronous electronic consultations via electronic health records (EHR) - and were limited in terms of design and types and dimensions of cross-level clinical coordination analysed. The evaluation of electronic consultations showed positive impacts on the appropriateness of referrals and accessibility to SC, yet the qualitative studies also highlighted potential risks. Studies on other mechanisms were scarce (shared EHR, email consultations) or non-existent (videoconferencing, mobile applications). Evidence of the impact of ICT-based mechanisms on clinical coordination between levels is limited. Rigorous evaluations are needed to inform policies and strategies for improving coordination between healthcare levels, thus contributing to high-quality, efficient healthcare.

Randomised trial of general practitioner online education for prescribing and test ordering

IntroductionPotentially inappropriate medicine prescriptions and low-value diagnostic testing pose risks to patient safety and increases in health system costs. The aim of the Clinical and Healthcare Improvement through My Health...

Factors affecting patient and public perceptions of the adoption of electronic health record sharing: A Hong Kong study

Background and ObjectivesThe disclosure of personal health information in electronic health records (eHR) highlights privacy and security concerns that are complicated by the digitization and interoperability of health records. Hong Kong’s Electronic Health Record Sharing System (eHRSS), introduced in March 2016, enables eHR sharing among public and private health services upon the consent of patients. Based on a September 2021 survey, this study examined the specific context of Hong Kong, patient and public perceptions on the security and privacy of eHR sharing, correlation of trust with personal privacy and security concerns, and how perceptions affect health care-related decisions. MethodsUsing a random sample of householders aged 45–70 years, the study conducted a questionnaire survey on respondents’ awareness, perceived benefits, and obstacles to participating in the eHRSS, and the impact of their perceptions on health care-related decisions. A focus group discussion with 13 participants further explored views on the security of Hong Kong’s eHRSS and their readiness to support the system. ResultsThe study analyzed data from 400 responses. The findings showed a low degree of awareness of the eHRSS. Privacy and security concerns were impeding factors in the sharing of information; half of the respondents reported being concerned over their personal health information being part of the eHRSS. The majority (86.9%) expressed conditional support for the sharing of information. Despite their concerns on security and privacy, 66.5% and 77.9%, respectively, would not withhold information nor postpone the seeking of medical care based on those concerns. Participants in the focus group expressed concerns regarding eHRSS registration, data leaks, information accuracy, and the potential prejudice that may result in discrimination and inequality in health care provision. ConclusionsSatisfaction with the health care services played a role in the trust reposed in the Hospital Authority and health care providers and institutions. Security and privacy were decisive factors in respodents’ refusal to seek care from physicians who had violated their privacy. Respondents expressed greater interest in sharing their information if measures were in place for anonymization and punishing data misuse. Ensuring rights of control toward information sharing would inspire greater confidence among patients.

Usage of electronic health record (eHR) viewer among healthcare professionals (HCProfs): A territory-wide study of 3972 participants

BackgroundThe Electronic Health Record Sharing System (eHRSS) is an electronic platform for two-way communication between the public and private sectors in Hong Kong. The authorised healthcare professionals (HCProfs) could access and upload patients’ health records on the eHR Viewer in the eHRSS. This study aims to evaluate the usage of eHR viewer among the HCProfs from the private sector by 1) examining the correlation of various factors and the data access of eHR viewer; 2) investigating the trend on data access and upload to eHR viewer by time period and domain. MethodsA total of 3972 HCProfs from private hospitals, group practice, and solo practice were included in the study. Regression analysis was performed to identify the correlation between various factors and the data access to eHR viewer. Trends on accessing and data uploading to eHR viewer by time period and domains were evaluated. Trends on data uploading to eHR viewer by time period and domains were presented in the line chart as well. FindingsAll types of HCProfs had a higher likelihood of accessing the eHR viewer as compared to those from private hospitals. HCProfs with specialities (apart from anaesthesia) had a higher possibility of accessing the eHR viewer than general practitioners without specialities. HCProfs participating in the Public-Private Partnership (PPP) Programme and the eHealth System (Subsidies) (eHS(S)) were more likely to access the eHR viewer. The overall trend of accessing eHR viewer was rising notably from 2016 to 2022, every domain showed rising trends, especially the laboratory domain with a 5-times increase between 2016 and 2022. ConclusionHCProfs with speciality were more likely to access the eHR viewer (except anaesthesiology), compared with the general practitioners. Participation in the PPP programmes and eHS(S) also increased the access rate of the eHR viewer. Besides, the use of eHR viewer (accessing and data uploading) would be influenced by social policy and the epidemic. Future research should focus on the impact of government programmes on eHRSS adoption.

Associations between adoption of eHealth management module and optimal control of HbA1c in diabetes patients

In January 2021, the eHealth App was launched in Hong Kong by the Hong Kong government to support the Electronic Health Record Sharing System (eHRSS). A Health Management Module in the eHealth App introduced new functions to record blood pressure, blood sugar, and heart rate, and downloading and sharing records. This study aims to compare the level of glycaemic control between users of the eHealth App and non-users. Type 2 diabetes patients who have joined the eHRSS with existing haemoglobin A1c (HbA1c) level records are recruited. Correlations between predictors and optimal HbA1c control (<7%) are examined using logistic regression analyses. A total of 109,823 participants are included, with 76,356 non-users of eHealth App, 31,723 users of eHealth App, and 1744 users of the eHealth Management Module together with the App. We collect HbA1c values from Jan 2021 to May 2022, and they are 6 months after the use of the App on average. Users of the eHealth Management Module are found to have more optimal HbA1c levels across all subgroups, with the strongest effect observed in younger females (aOR = 1.66, 95% CI = 1.27–2.17). eHealth App usage is also positively associated with optimal HbA1c levels, particularly amongst younger females (aOR = 1.17, 95% CI = 1.08–1.26). Overall, users of eHealth App and eHealth Management Module demonstrate more optimal HbA1c levels when compared with non-users, particularly among younger adults and females. These findings support its potential adoption in diabetes patients. Future studies should examine the impact of eHealth interventions on other clinical targets and diabetes complications.

Federated Learning-Based Secure Electronic Health Record Sharing Scheme in Medical Informatics.

Medical Cyber-Physical Systems support the mobility of electronic health records data for clinical research to accelerate new scientific discoveries. Artificial Intelligence improves medical informatics, but current centralized data training and insecure data storage management techniques expose private medical data to unauthorized foreign entities. In this paper, a Federated Learning-based Electronic Health Record sharing scheme is proposed for Medical Informatics to preserve patient data privacy. A decentralized Federated Learning-based Convolutional Neural Network model trains data locally in the hospital and stores results in a private InterPlanetary File System. A secondary global model is trained at the research center using the local models. Private IPFS secures all medical data stored locally in the hospital. The novelty of this study resides in securing valuable hospital biomedical data useful for clinical research organizations. Blockchain and smart contracts enable patients to negotiate with external entities for rewards in exchange for their data. Evaluation results demonstrate that the decentralized CNN model performs better in accuracy, sensitivity, and specificity, similar to the traditional centralized model. The performance of the Private IPFS exceeds the Blockchain-based IPFS based on file upload and download time. The scheme is suitable for promoting a secure and privacy-friendly environment for sharing data with clinical research centers for biomedical research.

Time-Enabled and Verifiable Secure Search for Blockchain-Empowered Electronic Health Record Sharing in IoT

The collection and sharing of electronic health records (EHRs) via the Internet of Things (IoT) can enhance the accuracy of disease diagnosis. However, it is challenging to guarantee the secure search of EHR during the sharing process. The advent of blockchain is a promising solution to address the issues, owing to its remarkable features such as immutability and anonymity. In this paper, we propose a novel blockchain-based secure sharing system over searchable encryption and hidden data structure via IoT devices. EHR ciphertexts of data owners are stored in the interplanetary file system (IPFS). A user with proper access permissions can search for the desired data with the data owner’s time-bound authorization and verify the authenticity of the search result. After that, the data user can access the relevant EHR ciphertext from IPFS using a symmetric key. The scheme jointly uses searchable encryption and smart contract to realize secure search, time control, verifiable keyword search, fast search, and forward privacy in IoT scenarios. Performance analysis and proof demonstrate that the proposed protocol can satisfy the design goals. In addition, performance evaluation shows the high scalability and feasibility of the proposed scheme.

Preserving Patient Privacy During Computation over Shared Electronic Health Record Data.

Patient Electronic Health Records (EHRs) contain valuable clinical data that is useful for medical research and public health inquires. However, patient privacy regulation and improper resource sharing risks limit access to EHR medical data for research and public health purposes. In this paper, we introduce an end-to-end security solution that addresses both concerns and facilitates the sharing of patient EHR data over an unsecured third-party server using a leveled homomorphic encryption (LHE) scheme. Time testing for aggregating queries and linear computations was carried out using an HPE ProLiant DL580 Gen 10 server with an Intel Xeon Platinum 8280 Processor.

Survey on Security and Interoperability of Electronic Health Record Sharing Using Blockchain Technology

Survey on Security and Interoperability of Electronic Health Record Sharing Using Blockchain Technology

Adjusting for Patient Economic/Access Issues in a Hypertension Quality Measure

The American Heart Association and American College of Cardiology have proposed adjusting hypertension-related care quality measures by excluding patients with economic/access issues from the denominator of rate calculations. No research to date has explored the methods to operationalize this recommendation or how to measure economic/access issues. This study applied and compared different approaches to populating these denominator exceptions. Electronic health record data from 2019 were used in 2021 to calculate hypertension control rates in 84 community health centers. A total of 10 different indicators of patient economic/access barriers to care were used as denominator exclusions to calculate and then compare adjusted quality measure performance. Data came from a nonprofit health center‒controlled network that hosts a shared electronic health record for community health centers located in 22 states. A total of 5 of 10 measures yielded an increase in adjusted hypertension control rates in ≥50% of clinics (average rate increases of 0.7-3.71 percentage points). A total of 3 of 10 measures yielded a decrease in adjusted hypertension control rates in >50% of clinics (average rate decreases of 1.33-13.82 percentage points). A total of 5 measures resulted in excluding >50% of the clinic's patient population from quality measure assessments. Changes in clinic-level hypertension control rates after adjustment differed depending on the measure of economic/access issue. Regardless of the exclusion method, changes between baseline and adjusted rates were small. Removing community health center patients experiencing economic/access barriers from a hypertension control quality measure resulted in excluding a large proportion of patients, raising concerns about whether this calculation can be a meaningful measure of clinical performance.

Privacy Preservation and Access Control for Sharing Electronic Health Records Using Blockchain Technology

Sharing of Electronic Health Records (EHRs) is of significant importance in health care. Lately, a cloud-based electronic health record sharing scheme has been used extensively to share patient records among various healthcare organizations. However, cloud centralization may compromise patients&#8217; privacy and security. Due to the special features of blockchain, it is important to see this technology as a promising solution to resolve these issues. This article proposes a privacy-preserving, secure EHR sharing and access control framework based on blockchain technology. The proposal aims to implement EHR blockchain technology and ensure that electronic records are stored safely by specifying user access permissions. We emulate the cryptographic primitives and use smart contracts to describe the relationships between the EHR owner and EHR user through the proposed system on the Ethereum blockchain. We assess the proposal results based on encryption and decryption time and the costs of the smart contract. The encryption and decryption times are proportional to the size of the EHR, which varies from 128 KB to 128 MB. When it comes to encryption, the smallest EHR takes 0.0012 s to encrypt, while the largest EHR, which is 128 MB, takes 1.4149 s. On the other hand, a 128 KB EHR takes 0.0013 s to decrypt, whereas a 128 MB EHR requires 1.6284 s. As a result, performance evaluation and security analysis confirm that the proposal is secure for practical application.

An Innovative Telemedical Network to Improve Infectious Disease Management in Critically Ill Patients and Outpatients (TELnet@NRW): Stepped-Wedge Cluster Randomized Controlled Trial.

BackgroundEvidence-based infectious disease and intensive care management is more relevant than ever. Medical expertise in the two disciplines is often geographically limited to university institutions. In addition, the interconnection between inpatient and outpatient care is often insufficient (eg, no shared electronic health record and no digital transfer of patient findings).ObjectiveThis study aims to establish and evaluate a telemedical inpatient-outpatient network based on expert teleconsultations to increase treatment quality in intensive care medicine and infectious diseases.MethodsWe performed a multicenter, stepped-wedge cluster randomized trial (February 2017 to January 2020) to establish a telemedicine inpatient-outpatient network among university hospitals, hospitals, and outpatient physicians in North Rhine-Westphalia, Germany. Patients aged ≥18 years in the intensive care unit or consulting with a physician in the outpatient setting were eligible. We provided expert knowledge from intensivists and infectious disease specialists through advanced training courses and expert teleconsultations with 24/7/365 availability on demand respectively once per week to enhance treatment quality. The primary outcome was adherence to the 10 Choosing Wisely recommendations for infectious disease management. Guideline adherence was analyzed using binary logistic regression models.ResultsOverall, 159,424 patients (10,585 inpatients and 148,839 outpatients) from 17 hospitals and 103 outpatient physicians were included. There was a significant increase in guideline adherence in the management of Staphylococcus aureus infections (odds ratio [OR] 4.00, 95% CI 1.83-9.20; P<.001) and in sepsis management in critically ill patients (OR 6.82, 95% CI 1.27-56.61; P=.04). There was a statistically nonsignificant decrease in sepsis-related mortality from 29% (19/66) in the control group to 23.8% (50/210) in the intervention group. Furthermore, the extension of treatment with prophylactic antibiotics after surgery was significantly less likely (OR 9.37, 95% CI 1.52-111.47; P=.04). Patients treated by outpatient physicians, who were regularly participating in expert teleconsultations, were also more likely to be treated according to guideline recommendations regarding antibiotic therapy for uncomplicated upper respiratory tract infections (OR 1.34, 95% CI 1.16-1.56; P<.001) and asymptomatic bacteriuria (OR 9.31, 95% CI 3.79-25.94; P<.001). For the other recommendations, we found no significant effects, or we had too few observations to generate models. The key limitations of our study include selection effects due to the applied on-site triage of patients as well as the limited possibilities to control for secular effects.ConclusionsTelemedicine facilitates a direct round-the-clock interaction over broad distances between intensivists or infectious disease experts and physicians who care for patients in hospitals without ready access to these experts. Expert teleconsultations increase guideline adherence and treatment quality in infectious disease and intensive care management, creating added value for critically ill patients.Trial RegistrationClinicalTrials.gov NCT03137589; https://clinicaltrials.gov/ct2/show/NCT03137589

Sharing medical data using a blockchain‐based secure EHR system for New Zealand

In New Zealand, the demand for healthcare services has grown gradually in the last decade, and it is likely to increase further. This had led to issues such as increasing treatment costs and processing time for the patients. To address the growing pressure in the healthcare sector, and its fragmented IT landscape that compounds the problems further, the New Zealand Ministry of Health aims to establish a shared Electronic Health Record (EHR) system that integrates all the major healthcare organisations such as hospitals, medical centres, and specialists. Due to its characteristics, blockchain technology could be a potential platform for building such large-scale health systems. Here, MedBloc, a blockchain-based secure EHR system that enables patients and healthcare providers to access and share health records while providing usability, security, and privacy is presented. MedBloc captures a longitudinal view of the patients’ health story and empowers the patients to regulate their own data by allowing them to give or withdraw consent for healthcare providers to access their records. To preserve the patients’ privacy and protect their health data, MedBloc uses an encryption scheme to secure records and smart contracts to enforce access control to prevent unauthorised access.

Good working relationships: how healthcare system proximity influences trust between healthcare workers

ABSTRACT Trust between healthcare workers is a fundamental component of effective, interprofessional collaboration and teamwork. However, little is known about how this trust is built, particularly when healthcare workers are distributed (i.e., not co-located and lack a shared electronic health record). We interviewed 39 healthcare workers who worked with proximal and distributed colleagues to care for patients with diabetic foot ulcers and analyzed transcripts using content analysis. Generally, building trust was a process that occurred over time, starting with an introduction and proceeding through iterative cycles of communication and working together to coordinate care for shared patients. Proximal, compared to distributed, dyads had more options available for interactions which, in turn, facilitated communication and working together to build trust. Distributed healthcare workers found it more difficult to develop trusting relationships and relied heavily on individual initiative to do so. Few effective tools existed at the level of interprofessional collaborations, teams, or broader healthcare systems to support trust between distributed healthcare workers. With increasing use of distributed interprofessional collaborations and teams, future efforts should focus on fostering this critical attribute.

MedShard: Electronic Health Record Sharing Using Blockchain Sharding

Electronic health records (EHRs) are important assets of the healthcare system and should be shared among medical practitioners to improve the accuracy and efficiency of diagnosis. Blockchain technology has been investigated and adopted in healthcare as a solution for EHR sharing while preserving privacy and security. Blockchain can revolutionize the healthcare system by providing a decentralized, distributed, immutable, and secure architecture. However, scalability has always been a bottleneck in blockchain networks due to the consensus mechanism and ledger replication to all network participants. Sharding helps address this issue by artificially partitioning the network into small groups termed shards and processing transactions parallelly while running consensus within each shard with a subset of blockchain nodes. Although this technique helps resolve issues related to scalability, cross-shard communication overhead can degrade network performance. This study proposes a transaction-based sharding technique wherein shards are formed on the basis of a patient’s previously visited health entities. Simulation results show that the proposed technique outperforms standard-based healthcare blockchain techniques in terms of the number of appointments processed, consensus latency, and throughput. The proposed technique eliminates cross-shard communication by forming complete shards based on “the need to participate” nodes per patient.

A Shared Electronic Health Record in a Rural Setting Maintains Hematological Cancer Services Remotely during the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic has had drastic effects on healthcare provision across Australia and the world. Rural hematology patients who may rely on visiting medical officers from larger cities or long distance travel for reviews are particularly vulnerable to having their treatment affected by the recent changes to healthcare delivery given severe travel restrictions.The Griffith Hematology/Oncology Unit is based in Griffith Base Hospital, a regional hospital in New South Wales, Australia. It is serviced by consultant hematologists from St Vincent's Hospital at the capital city of Sydney, Australia, who visit fortnightly to run hematology outreach clinics and supervise chemotherapy delivery. Griffith is located 575km from Sydney and has an estimated population of over 26,000(1). The COVID-19 pandemic imposed significant travel restrictions, such that visiting haematologists have been unable to travel to continue in-person clinics since April 2020. This has led to the exclusive reliance on telemedicine (telehealth and telephone reviews) and remote chemotherapy delivery supervision. Having an electronic health record (EHR) containing all relevant patient information which is remotely accessible to treating physicians has been integral to the continuity of comprehensive specialist cancer care in this rural setting via telemedicine.MethodsThe previously reported shared EHR between Griffith and St Vincent's Hospital, Sydney was used to review the impact of COVID-19 on service delivery in Griffith(2). All rural patient information was accessible from the metropolitan location including comprehensive documentation of a patient's clinical findings, routine observations, diagnostic pathology and radiology results, and details of treatment at the Griffith site. Remote chemotherapy prescribing and telemedicine notes were documented through the EHR.ResultsThe number of new referrals, follow ups and total patients over the four months prior to the COVID-19 related changes (December 2019 to March 2020) and the four months following (April to July 2020) were compared. From April 2020 onwards, the Griffith clinic patients underwent reviews via telemedicine or telephone with no in-person reviews able to be conducted in Griffith due to the travel restrictions. The number of new referrals, follows up visits and the total number of patients seen following the change to telemedicine had all increased with no reduction in service delivery seen (Table 1). The total number of patient reviews was 167 visits over the four months prior to the change, which increased to 186 reviews after the travel restrictions were applied.Despite the travel restrictions, the hematology outreach services to Griffith were maintained through telemedicine reviews in a similar manner to the metropolitan service. Griffith rural hematology patients continue to undergo regular telemedicine reviews with monitoring of laboratory and imaging results through the EHR, receiving the same level of care as metropolitan patients.Chemotherapy is still able to be prescribed, adjusted and reviewed from the Sydney location for all patients. The total number of chemotherapy treatment cycles delivered in Griffith only slightly decreased despite the changes to service provision, which was attributed to normal variation in patients requiring treatment over 2020 (Table 2). 32 chemotherapy treatment cycles were delivered prior to the change compared to 26 cycles following, for the primary indications of lymphoma and myeloma.ConclusionIn recent months, the centralised EHR has proven critical in minimising clinical service disruptions caused by the COVID-19 pandemic by facilitating telemedicine links and remote patient management. We demonstrate how the shared EHR has been integral to the continuation of complex rural patient management during the COVID-19 pandemic due to the availability of remotely accessible patient information and chemotherapy prescribing. No significant change in clinical service activity was seen following the drastic travel restrictions due to the pandemic. Given these travel restrictions are expected to continue, it is encouraging that the shared EHR will allow rural Griffith patients continued access to appropriate specialist hematology care over the coming months. This work demonstrates how an EHR is fundamental to the sustainability of vital cancer services for rural communities.DisclosuresHamad:Abbvie: Honoraria; Novartis: Honoraria.

Coordination of Care as Experienced by the Specialist: Validation of the CSC-Specialist Survey in the Private Sector and the Effect of a Shared Electronic Health Record.

We previously developed 2 complementary surveys to measure coordination of care as experienced by the specialist and the primary care provider (PCP). These Coordination of Specialty Care (CSC) surveys were developed in the Veterans Health Administration (VA), under an integrated organizational umbrella that includes a shared electronic health record (EHR). To develop an augmented version of the CSC-Specialist in the private sector and use that version (CSC-Specialist 2.0) to examine the effect of a shared EHR on coordination. We administered the survey online to a national sample of clinicians from 10 internal medicine subspecialties. We used multitrait analysis and confirmatory factor analysis to evaluate the psychometric properties of the original VA-based survey and develop an augmented private sector survey (CSC-Specialist 2.0). We tested construct validity by regressing a single-item measure of overall coordination onto the 4 scales. We used analysis of variance to examine the relationship of a shared EHR to coordination. Psychometric assessment supported the 13-item, 4-scale structure of the original VA measure and the augmented 18-item, 4-scale structure of the CSC-Specialist 2.0. The CSC-Specialist 2.0 scales together explained 45% of the variance in overall coordination. A shared EHR was associated with significantly better scores for the Roles and Responsibilities and Data Transfer scales, and for overall coordination. The CSC-Specialist 2.0 is a unique survey that demonstrates adequate psychometric performance and is sensitive to use of a shared EHR. It can be used alone or with the CSC-PCP to identify coordination problems, guide interventions, and measure improvements.

ACTION-EHR: Patient-Centric Blockchain-Based Electronic Health Record Data Management for Cancer Care.

BackgroundWith increased specialization of health care services and high levels of patient mobility, accessing health care services across multiple hospitals or clinics has become very common for diagnosis and treatment, particularly for patients with chronic diseases such as cancer. With informed knowledge of a patient’s history, physicians can make prompt clinical decisions for smarter, safer, and more efficient care. However, due to the privacy and high sensitivity of electronic health records (EHR), most EHR data sharing still happens through fax or mail due to the lack of systematic infrastructure support for secure, trustable health data sharing, which can also cause major delays in patient care.ObjectiveOur goal was to develop a system that will facilitate secure, trustable management, sharing, and aggregation of EHR data. Our patient-centric system allows patients to manage their own health records across multiple hospitals. The system will ensure patient privacy protection and guarantee security with respect to the requirements for health care data management, including the access control policy specified by the patient.MethodsWe propose a permissioned blockchain-based system for EHR data sharing and integration. Each hospital will provide a blockchain node integrated with its own EHR system to form the blockchain network. A web-based interface will be used for patients and doctors to initiate EHR sharing transactions. We take a hybrid data management approach, where only management metadata will be stored on the chain. Actual EHR data, on the other hand, will be encrypted and stored off-chain in Health Insurance Portability and Accountability Act–compliant cloud-based storage. The system uses public key infrastructure–based asymmetric encryption and digital signatures to secure shared EHR data.ResultsIn collaboration with Stony Brook University Hospital, we developed ACTION-EHR, a system for patient-centric, blockchain-based EHR data sharing and management for patient care, in particular radiation treatment for cancer. The prototype was built on Hyperledger Fabric, an open-source, permissioned blockchain framework. Data sharing transactions were implemented using chaincode and exposed as representational state transfer application programming interfaces used for the web portal for patients and users. The HL7 Fast Healthcare Interoperability Resources standard was adopted to represent shared EHR data, making it easy to interface with hospital EHR systems and integrate a patient’s EHR data. We tested the system in a distributed environment at Stony Brook University using deidentified patient data.ConclusionsWe studied and developed the critical technology components to enable patient-centric, blockchain-based EHR sharing to support cancer care. The prototype demonstrated the feasibility of our approach as well as some of the major challenges. The next step will be a pilot study with health care providers in both the United States and Switzerland. Our work provides an exemplar testbed to build next-generation EHR sharing infrastructures.