Traditional Electronic Health Record Research Articles

Advancing Healthcare Security: A Cutting-Edge Zero-Trust Blockchain Solution for Protecting Electronic Health Records

The effective management of electronic health records (EHRs) is vital in healthcare. However, traditional systems often need help handling data inconsistently, providing limited access, and coordinating poorly across facilities. This study aims to tackle these issues using blockchain technology to improve EHR systems' data security, privacy, and interoperability. By thoroughly analyzing blockchain's applications in healthcare, we propose an innovative solution that leverages blockchain's decentralized and immutable nature, combined with advanced encryption techniques such as the Advanced Encryption Standard and Zero Knowledge Proof Protocol, to fortify EHR systems. Our research demonstrates that blockchain can effectively overcome significant EHR challenges, including fragmented data and interoperability problems, by facilitating secure and transparent data exchange, leading to enhanced coordination, care quality, and cost-efficiency across healthcare facilities. This study offers practical guidelines for implementing blockchain technology in healthcare, emphasizing a balanced approach to interoperability, privacy, and security. It represents a significant advancement over traditional EHR systems, boosting security and affording patients greater control over their health records. Doi: 10.28991/HIJ-2023-04-03-012 Full Text: PDF

Broadening of horizons: a review of blockchains' influence on EHRs development trend

Electronic health records (EHR) improves the quality and effectiveness of healthcare. The introduction of blockchain opens up new paths in the development trend of EHR. This review aims to find the developmental trends of the EHR, blockchain-based EHR and its impact on EHR evolution. A total of 85 articles published in 2015 to 2021 were selected, addressing the general development of EHR. Development aspects of EHR addressed by each were analysed, hence tracing the path taken by each. Researchers for the betterment of traditional EHR sought to address usability, adaptability, needs of specialised areas, and patient inclusivity in the workflow, while stressing the application of EHR for predictive analysis, preventive healthcare, population health, etc. The literature on blockchain-based EHR contributed to mitigating the interoperability, promoting data sharing and patient-centric records. While traditional EHR deepens their reach into healthcare, blockchain-based EHR broadens the reach of healthcare itself.

Leveraging Blockchain-Based Electronic Health Record Systems in Healthcare 4.0

Digitalization has become a crucial part of healthcare 4.0 by transforming systems such as electronic health records (EHR), electronic medical records (EMR), and electronic personal medical records (ePHR). Healthcare 4.0 is derived from industry 4.0 and aims to enhance collaboration, virtualization, coherence, and convergence, which helps transform modern healthcare into more personalized and predictive. Healthcare 4.0 also aims to develop digital enablers which will support coordination among various stakeholders and seamless information flow in the patient journey towards wellbeing. These systems enhance patient care through the timely sharing of patient data across different providers globally. Timely sharing helps, but it also makes the electronic system vulnerable to alteration and breaches. In healthcare, blockchain application is widely used in various areas, such as health information exchange, pharmaceutical counterfeit, clinical trials, health supply chain management, patient data management, insurance claims, and product recall in case of adverse events. This research paper aims to identify how blockchain technology can help enhance the privacy and security of electronic health record systems. This paper discusses various blockchain-based systems, which provide a more efficient and secure option than client-server architecture-based traditional EHR systems.

A Granular Approach to Secure the Privacy of Electronic Health Records Through Blockchain Technology

The method of storing data in traditional Electronic Health Records (EHRs) becomes even more obsolete when it has to undertake data from more than one institution. This problem is bigger than it seems as, most of the times the patients' medical data is scattered among various Healthcare Centers. Also, these multiple and inconsistent health records are almost never reviewed which further makes them unreliable. All this can be achieved by implementing the Blockchain Technology into the traditional Electronic Health Records. We propose a blockchain technology based Electronic Health Record portal for patients, doctors, and other users to provide temper proof, secure, and efficient access to health records while maintaining the privacy of patient’s health records. The aim of this paper is to deal with the various needs of patients, doctors, and third parties, as well as to see how the system could resolve privacy and security issues in the healthcare industry.

Blockchain-Based Electronic Health Records Management: A Comprehensive Review and Future Research Direction

Electronic Health Records (EHRs) are electronically-stored health information in a digital format. EHRs are typically shared among healthcare stakeholders and face power failure, data misuse, lack of privacy, security, and audit trail. On the other hand, blockchain is the revolutionary invention of the twentieth century that offers a distributed and decentralized setting to communicate among nodes in a list of networks without a central authority. It can address the limitations of EHRs management and provide a safer, secured, and decentralized environment for exchanging EHRs data. Three categories of blockchain-based potential solutions have been proposed by researchers to handle EHRs: conceptual, prototype, and implemented. This study focused on a Systematic Literature Review (SLR) to find and analyze articles submitted either conceptual or implemented to manage EHRs using blockchain. The study examined 99 papers that were collected from various publication categories. The deep technical analysis focused on evaluating articles based on privacy, security, scalability, accessibility, cost, consensus algorithms, and the type of blockchain used. The SLR found that blockchain technology promises to provide decentralization, security, and privacy that traditional EHRs often lack. Moreover, results obtained from the detailed studies would provide potential researchers with the type of blockchain for future research. Finally, future research directions, in the end, would direct enthusiasm to combine new blockchain-based systems to manage EHRs properly.

Systematic Review on AI-Blockchain Based E-Healthcare Records Management Systems

Electronic health records (EHRs) are digitally saved health records that provide information about a person’s health. EHRs are generally shared among healthcare stakeholders, and thus are susceptible to power failures, data misuse, a lack of privacy, security, and an audit trail, among other problems. Blockchain, on the other hand, is a groundbreaking technology that provides a distributed and decentralized environment in which nodes in a list of networks can connect to each other without the need for a central authority. It has the potential to overcome the limits of EHR management and create a more secure, decentralized, and safer environment for exchanging EHR data. Further, blockchain is a distributed ledger on which data can be stored and shared in a cryptographically secure, validated, and mutually agreed-upon manner across all mining nodes. The blockchain stores data with a high level of integrity and robustness, and it cannot be altered. When smart contracts are used to make decisions and conduct analytics with machine-learning algorithms, the results may be trusted and unquestioned. However, Blockchain is not always indestructible and suffers from scalability and complexity issues that might render it inefficient. Combining AI and blockchain technology can handled some of the drawbacks of these two technical ecosystems effectively. AI algorithms rely on data or information to learn, analyze, and reach conclusions. The performance of AI algorithms is enhanced through the data obtained from a data repository or a reliable, secure, trustworthy, and credible platform. Researchers have identified three categories of blockchain-based potential solutions for the management of electronic health records: conceptual, prototype, and implemented. The purpose of this research work is to conduct a Systematic Literature Review (SLR) to identify and assess research articles that were either conceptual or implemented to manage EHRs using blockchain technology. The study conducts a comprehensive evaluation of the literature on blockchain technology and enhanced health record management systems utilizing artificial intelligence technologies. The study examined 189 research papers collected from various publication categories. The in-depth analysis focuses on the privacy, security, accessibility, and scalability of publications. The SLR has illustrated that blockchain technology has the potential to deliver decentralization, security, and privacy that are frequently lacking in traditional EHRs. Additionally, the outcomes of the extensive analysis inform future researchers about the type of blockchain to use in their research. Additionally, methods used in healthcare are summarized per application area while their pros and cons are highlighted. Finally, the emphasized taxonomy combines blockchain and artificial intelligence, which enables us to analyze possible blockchain and artificial intelligence applications in health records management systems. The article ends with a discussion on open issues for research and future directions.

The HealthChain Blockchain for Electronic Health Records: Development Study.

BackgroundHealth care professionals are required to maintain accurate health records of patients. Furthermore, these records should be shared across different health care organizations for professionals to have a complete review of medical history and avoid missing important information. Nowadays, health care providers use electronic health records (EHRs) as a key to the implementation of these goals and delivery of quality care. However, there are technical and legal hurdles that prevent the adoption of these systems, such as concerns about performance and privacy issues.ObjectiveThis study aimed to build and evaluate an experimental blockchain for EHRs, named HealthChain, which overcomes the disadvantages of traditional EHR systems.MethodsHealthChain is built based on consortium blockchain technology. Specifically, three organizations, namely hospitals, insurance providers, and governmental agencies, form a consortium that operates under a governance model, which enforces the business logic agreed by all participants. Every peer node hosts an instance of the distributed ledger consisting of EHRs and an instance of chaincode regulating the permissions of participants. Designated orderers establish consensus on the order of EHRs and then disseminate blocks to peers.ResultsHealthChain achieves functional and nonfunctional requirements. It can store EHRs in a distributed ledger and share them among different participants. Moreover, it demonstrates superior features, such as privacy preservation, security, and high throughput. These are the main reasons why HealthChain is proposed.ConclusionsConsortium blockchain technology can help to build new EHR systems and solve the problems that prevent the adoption of traditional systems.

Design of Secure Protocol for Cloud-Assisted Electronic Health Record System Using Blockchain.

In the traditional electronic health record (EHR) management system, each medical service center manages their own health records, respectively, which are difficult to share on the different medical platforms. Recently, blockchain technology is one of the popular alternatives to enable medical service centers based on different platforms to share EHRs. However, it is hard to store whole EHR data in blockchain because of the size and the price of blockchain. To resolve this problem, cloud computing is considered as a promising solution. Cloud computing offers advantageous properties such as storage availability and scalability. Unfortunately, the EHR system with cloud computing can be vulnerable to various attacks because the sensitive data is sent over a public channel. We propose the secure protocol for cloud-assisted EHR system using blockchain. In the proposed scheme, blockchain technology is used to provide data integrity and access control using log transactions and the cloud server stores and manages the patient’s EHRs to provide secure storage resources. We use an elliptic curve cryptosystems (ECC) to provide secure health data sharing with cloud computing. We demonstrate that the proposed EHR system can prevent various attacks by using informal security analysis and automated validation of internet security protocols and applications (AVISPA) simulation. Furthermore, we prove that the proposed EHR system provides secure mutual authentication using BAN logic analysis. We then compare the computation overhead, communication overhead, and security properties with existing schemes. Consequently, the proposed EHR system is suitable for the practical healthcare system considering security and efficiency.

Twilighted Homegrown Systems: The Experience of Six Traditional Electronic Health Record Developers in the Post-Meaningful Use Era.

Objectives This study aimed to understand if and how homegrown electronic health record (EHR) systems are used in the post–Meaningful Use (MU) era according to the experience of six traditional EHR developers. Methods We invited informatics leaders from a convenience sample of six health care organizations that have recently replaced their long used homegrown systems with commercial EHRs. Participants were asked to complete a written questionnaire with open-ended questions designed to explore if and how their homegrown system(s) is being used and maintained after adoption of a commercial EHR. We used snowball sampling to identify other potential respondents and institutions. Results Participants from all six organizations included in our initial sample completed the questionnaire and provided referrals to four other organizations; from these, two did not respond to our invitations and two had not yet replaced their system and were excluded. Two organizations (Columbia University and University of Alabama at Birmingham) still use their homegrown system for direct patient care and as a downtime system. Four organizations (Intermountain Healthcare, Partners Healthcare, Regenstrief Institute, and Vanderbilt University) kept their systems primarily to access historical data. All organizations reported the need to continue to develop or maintain local applications despite having adopted a commercial EHR. The most common applications developed include display and visualization tools and clinical decision support systems. Conclusion Homegrown EHR systems continue to be used for different purposes according to the experience of six traditional homegrown EHR developers. The annual cost to maintain these systems varies from $21,000 to over 1 million. The collective experience of these organizations indicates that commercial EHRs have not been able to provide all functionality needed for patient care and local applications are often developed for multiple purposes, which presents opportunities for future research and EHR development.

Decentralized Electronic Health Record System

With a view to overcome the shortcomings of traditional Electronic Health Record (EHR) system so as to assure the interoperability by providing open access to sensitive health data, while still preserving personal data privacy, anonymity and avoiding data misuse, Decentralized Electronic Health Record System was developed. The aforementioned issue concerning traditional EHR system can be addressed by implication of emerging technology of the era namely Block chain, together with Inter Planetary File System (IPFS) which enables data sharing in decentralized and transactional fashion, thereby maintaining delicate balance between privacy and accessibility of electronic health records. A block chain based EHR system has been built for secure, efficient and interoperable access to medical records by both patients and doctors while preserving privacy of the sensitive patient’s information. Patients can easily and comprehensively access to their medical records across providers and treatment sites using unique properties of block chain and decentralized storage. A separate portal for both the patients and doctors has been built enabling the smart contracts to handle further interaction between doctors and patients. So, in this system, it is demonstrated how principles of decentralization and block chain architectures could contribute to EHR system using Ethereum smart contracts and IPFS to orchestrate a suitable system governing the medical record access while providing patients with comprehensive record review along with consideration for audit ability and data sharing.

An OpenEHR Adoption in a Portuguese Healthcare Facility

The quality and safety of clinical decisions depend to a large extent on the knowledge acquired by the records of health professionals. However, a traditional Electronic Health Record (EHR) has become insufficient in terms of knowledge acquisition and clinical decision support. The development of these aspects may bring marked improvements in the quality and safety of health care. The usage of open models promotes interoperability between systems, minimizing the impact of information systems on the efficient production of knowledge useful for clinical decisions. In this sense, this article describes an implementation project of a system that support the production and use of knowledge in clinical environments, based on OpenEHR two levels modelling open data approach, in a healthcare facility on the north of Portugal.

A Systematic Review of Blockchain in Healthcare: Frameworks, Prototypes, and Implementations

Blockchain, a form of distributed ledger technology has attracted the interests of stakeholders across several sectors including healthcare. Its’ potential in the multi-stakeholder operated sector like health has been responsible for several investments, studies, and implementations. Electronic Health Records (EHR) systems traditionally used for the exchange of health information amongst healthcare stakeholders have been criticised for centralising power, failures and attack-points with exchange data custodians. EHRs have struggled in the face of multi-stakeholder and system requirements while adhering to security, privacy, ethical and other regulatory constraints. Blockchain is promising amongst others to address the many EHR challenges, primarily trustless and secure exchange of health information amongst stakeholders. Many blockchain-in-healthcare frameworks have been proposed; some prototyped and/or implemented. This study leveraged the PRISMA framework to systematically search and evaluate the different models proposed; prototyped and/or implemented. The bibliometric and functional distribution of all 143 articles from this study were presented. This study evaluated 61 articles that discussed either prototypes or pilot or implementations. The technical and architectural analysis of these 61 articles for privacy, security, cost, and performance were detailed. Blockchain was found to solve the trust, security and privacy constraints of traditional EHRs often at significant performance, storage and cost trade-offs.

Geographic surveillance of community associated MRSA infections in children using electronic health record data

BackgroundCommunity- associated methicillin resistant Staphylococcus aureus (CA-MRSA) cause serious infections and rates continue to rise worldwide. Use of geocoded electronic health record (EHR) data to prevent spread of disease is limited in health service research. We demonstrate how geocoded EHR and spatial analyses can be used to identify risks for CA-MRSA in children, which are tied to place-based determinants and would not be uncovered using traditional EHR data analyses.MethodsAn epidemiology study was conducted on children from January 1, 2002 through December 31, 2010 who were treated for Staphylococcus aureus infections. A generalized estimated equations (GEE) model was developed and crude and adjusted odds ratios were based on S. aureus risks. We measured the risk of S. aureus as standardized incidence ratios (SIR) calculated within aggregated US 2010 Census tracts called spatially adaptive filters, and then created maps that differentiate the geographic patterns of antibiotic resistant and non-resistant forms of S. aureus.ResultsCA-MRSA rates increased at higher rates compared to non-resistant forms, p = 0.01. Children with no or public health insurance had higher odds of CA-MRSA infection. Black children were almost 1.5 times as likely as white children to have CA-MRSA infections (aOR 95% CI 1.44,1.75, p < 0.0001); this finding persisted at the block group level (p < 0.001) along with household crowding (p < 0.001). The youngest category of age (< 4 years) also had increased risk for CA-MRSA (aOR 1.65, 95%CI 1.48, 1.83, p < 0.0001). CA-MRSA encompasses larger areas with higher SIRs compared to non-resistant forms and were found in block groups with higher proportion of blacks (r = 0.517, p < 0.001), younger age (r = 0.137, p < 0.001), and crowding (r = 0.320, p < 0.001).ConclusionsIn the Atlanta MSA, the risk for CA-MRSA is associated with neighborhood-level measures of racial composition, household crowding, and age of children. Neighborhoods which have higher proportion of blacks, household crowding, and children < 4 years of age are at greatest risk. Understanding spatial relationship at a community level and how it relates to risks for antibiotic resistant infections is important to combat the growing numbers and spread of such infections like CA-MRSA.

An Efficient Authentication Scheme for Blockchain-Based Electronic Health Records

In traditional electronic health records (EHRs), medical-related information is generally separately controlled by different hospitals and thus it leads to the inconvenience of information sharing. Cloud-based EHRs solve the problem of information sharing in the traditional EHRs. However, cloud-based EHRs suffer the centralized problem, i.e., cloud service center and key-generation center. This paper works on creating a new EHRs paradigm which can help in dealing with the centralized problem of cloud-based EHRs. Our solution is to make use of the emerging technology of blockchain to EHRs (denoted as blockchain-based EHRs for convenience). First, we formally define the system model of blockchain-based EHRs in the setting of consortium blockchain. In addition, the authentication issue is very important for EHRs. However, existing authentication schemes for blockchain-based EHRs have their own weak points. Therefore, in this paper, we also propose an authentication scheme for blockchain-based EHRs. Our proposal is an identity-based signature scheme with multiple authorities which can resist collusion attack out of N from N-1 authorities. Furthermore, our scheme is provably secure in the random oracle model and has more efficient signing and verification algorithms than existing authentication schemes of blockchain-based EHRs.

Putting Meaning into Meaningful Use: A Roadmap to Successful Integration of Evidence at the Point of Care.

Pressures to contain health care costs, personalize patient care, use big data, and to enhance health care quality have highlighted the need for integration of evidence at the point of care. The application of evidence-based medicine (EBM) has great promise in the era of electronic health records (EHRs) and health technology. The most successful integration of evidence into EHRs has been complex decision tools that trigger at a critical point of the clinical visit and include patient specific recommendations. The objective of this viewpoint paper is to investigate why the incorporation of complex CDS tools into the EMR is equally complex and continues to challenge health service researchers and implementation scientists. Poor adoption and sustainability of EBM guidelines and CDS tools at the point of care have persisted and continue to document low rates of usage. The barriers cited by physicians include efficiency, perception of usefulness, information content, user interface, and over-triggering. Building on the traditional EHR implementation frameworks, we review keys strategies for successful CDSs: (1) the quality of the evidence, (2) the potential to reduce unnecessary care, (3) ease of integrating evidence at the point of care, (4) the evidence’s consistency with clinician perceptions and preferences, (5) incorporating bundled sets or automated documentation, and (6) shared decision making tools. As EHRs become commonplace and insurers demand higher quality and evidence-based care, better methods for integrating evidence into everyday care are warranted. We have outlined basic criteria that should be considered before attempting to integrate evidenced-based decision support tools into the EHR.

Cloud-Based Development of Smart and Connected Data in Healthcare Application

There is a need of data integration in cloud – based system, we propose an Information Integration and Informatics framework for cloud – based healthcare application. The data collected by the Electronic Health Record System need to be smart and connected, so we use informatica for the connection of data from different database. Traditional Electronic Health Record Systems are based on different technologies, languages and Electronic Health Record Standards. Electronic Health Record System stores data based on interaction between patient and provider. There are scalable cloud infrastructures, distributed and heterogeneous healthcare systems and there is a need to develop advanced healthcare application. This advance healthcare application will improve the integration of required data and helps in fast interaction between the patient and the service providers. Thus there is the development of smart and connected data in healthcare application of cloud. The proposed system is developed by using cloud platform Aneka.

Reconciliation of the cloud computing model with US federal electronic health record regulations

Cloud computing refers to subscription-based, fee-for-service utilization of computer hardware and software over the Internet. The model is gaining acceptance for business information technology (IT) applications because it allows capacity and functionality to increase on the fly without major investment in infrastructure, personnel or licensing fees. Large IT investments can be converted to a series of smaller operating expenses. Cloud architectures could potentially be superior to traditional electronic health record (EHR) designs in terms of economy, efficiency and utility. A central issue for EHR developers in the US is that these systems are constrained by federal regulatory legislation and oversight. These laws focus on security and privacy, which are well-recognized challenges for cloud computing systems in general. EHRs built with the cloud computing model can achieve acceptable privacy and security through business associate contracts with cloud providers that specify compliance requirements, performance metrics and liability sharing.

Designing electronic health records versus total digital health systems: A systemic analysis

AbstractTo date, the digitization of health care typically has focussed simply and solely on electronic records for patients. Most systems are relational databases with a finite number of intra‐enterprise applications and are limited to in‐house use by health care facilities. Very few of these systems have realized fully functional, scalable, distribution capabilities, not to mention interoperability with external systems. This short‐sighted tendency to build large‐scale but restrictive automated systems that ignore the interactive nature of health care has resulted in limited operational success and acceptance. That said, this trend is not irreversible. Given the right circumstances, distributed, interoperable, digital health systems could emerge rapidly, offering both intra‐ and inter‐enterprise benefits. To succeed, the design of these so‐called total digital health systems (TDHSs) must be approached holistically, incorporating such properties of health care delivery systems as softness, openness, complexity, flexibility and generality. Because of the procedural nature of most electronic health record (EHR) applications now in use, traditional system approaches—such as the relational database model to application design—would be adequate for EHRs. This paper discusses the systemic nature of health care information systems and compares and contrasts the traditional EHR with TDHS. A soft systems methodology (SSM) is proposed for TDHS design. Copyright © 2008 John Wiley &amp; Sons, Ltd.

A Tamper-Resistant and Portable Healthcare Folder

Electronic health record (EHR) projects have been launched in most developed countries to increase the quality of healthcare while decreasing its cost. The benefits provided by centralizing the healthcare information in database systems are unquestionable in terms of information quality, availability, and protection against failure. Yet, patients are reluctant to give to a distant server the control over highly sensitive data (e.g., data revealing a severe or shameful disease). This paper capitalizes on a new hardware portable device, associating the security of a smart card to the storage capacity of a USB key, to give back to the patient the control over his medical data. This paper shows how this device can complement a traditional EHR server to (1) protect and share highly sensitive data among trusted parties and (2) provide a seamless access to the data even in disconnected mode. The proposed architecture is experimented in the context of a medicosocial network providing medical care and social services at home for elderly people.

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

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