A novel system architecture for the national integration of electronic health records: a semi-centralized approach

BEST-Blockchain-Enabled Secure and Trusted Public Emergency Services for Smart Cities Environment

In the last few years, the Internet of things (IoT) has recently gained attention in developing various smart city applications such as smart healthcare, smart supply chain, smart home, smart grid, etc. The existing literature focuses on the smart healthcare system as a public emergency service (PES) to provide timely treatment to the patient. However, little attention is given to a distributed smart fire brigade system as a PES to protect human life and properties from severe fire damage. The traditional PES are developed on a centralised system, which requires high computation and does not ensure timely service fulfilment. Furthermore, these traditional PESs suffer from a lack of trust, transparency, data integrity, and a single point of failure issue. In this context, this paper proposes a Blockchain-Enabled Secure and Trusted (BEST) framework for PES in the smart city environment. The BEST framework focuses on providing a fire brigade service as a PES to the smart home based on IoT device information to protect it from serious fire damage. Further, we used two edge computing servers, an IoT controller and a service controller. The IoT and service controller are used for local storage and to enhance the data processing speed of PES requests and PES fulfilments, respectively. The IoT controller manages an access control list to keep track of registered IoT gateways and their IoT devices, avoiding misguiding the PES department. The service controller utilised the queue model to handle the PES requests based on the minimum service queue length. Further, various smart contracts are designed on the Hyperledger Fabric platform to automatically call a PES either in the presence or absence of the smart-home owner under uncertain environmental conditions. The performance evaluation of the proposed BEST framework indicates the benefits of utilising the distributed environment and the smart contract logic. The various simulation results are evaluated in terms of service queue length, utilisation, actual arrival time, expected arrival time, number of PES departments, number of PES providers, and end-to-end delay. These simulation results show the effectiveness and feasibility of the BEST framework.

Barriers to the Adoption of Electronic Medical Record System in Ethiopia: A Systematic Review

Background

Electronic medical records (EMRs) can improve the quality of health care and patient safety. Various countries have gone through the local application of EMRs to various health care organizations in national implementation and integration of EMRs. Ethiopia lags far in the back in this regard, as solely some hospitals have implemented EMR.

Objective

This study aimed to identify barriers to the adoption of EMRs in Ethiopia through a systematic review of the literature.

Methods

PubMed, Semantic Scholar, and Google Scholar have been searched for applicable articles. The search method focuses on peer-reviewed, empirical research conducted in Ethiopia. The ultimate set that met the inclusion standards was 9 studies. The authors extracted, analyzed, and summarized empirical results associated with EMR barriers in these studies.

Results

This systematic review identified the following 17 barriers to EMR adoption: absence of EMR training, limited access to computers, insufficient computer literacy, deficiency of EMR knowledge, inadequate technical help, absence of EMR manual, negative attitude to EMR, limited internet access, lack of management support, electric power interruption, absence of perceived system quality, absence of perceived information quality, lack of willingness, the complexity of the system, performance expectancy, effort expectancy, and lack of IT qualification.

Conclusion

The most common barriers for EMR adoption are absence of EMR training, limited access to a computer, poor computer literacy, poor EMR knowledge, lack of technical support, and absence of an EMR manual. As this study summarizes the available evidence regarding barriers to adopting EMR in Ethiopia, future research will rest on this evidence and specialize in building a proper framework for EMR implementation in Ethiopia.

Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach

BACKGROUND

The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving.

OBJECTIVE

This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture.

METHODS

The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution.

RESULTS

The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data.

CONCLUSIONS

The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.

A Systematic Literature Review on Security and Privacy of Electronic Health Record Systems: Technical Perspectives

Background:

Even though many safeguards and policies for electronic health record (EHR) security have been implemented, barriers to the privacy and security protection of EHR systems persist.

Objective:

This article presents the results of a systematic literature review regarding frequently adopted security and privacy technical features of EHR systems.

Method:

Our inclusion criteria were full articles that dealt with the security and privacy of technical implementations of EHR systems published in English in peer-reviewed journals and conference proceedings between 1998 and 2013; 55 selected studies were reviewed in detail. We analysed the review results using two International Organization for Standardization (ISO) standards (29100 and 27002) in order to consolidate the study findings.

Results:

Using this process, we identified 13 features that are essential to security and privacy in EHRs. These included system and application access control, compliance with security requirements, interoperability, integration and sharing, consent and choice mechanism, policies and regulation, applicability and scalability and cryptography techniques.

Conclusion:

This review highlights the importance of technical features, including mandated access control policies and consent mechanisms, to provide patients' consent, scalability through proper architecture and frameworks, and interoperability of health information systems, to EHR security and privacy requirements.

The effect of electronic medical record application on the length of stay in a Chinese general hospital: a department- and disease-focused interrupted time-series study

A key purpose of electronic medical records (EMR) introduced in medical institutions is to improve work efficiency. The average length of stay (LOS) is just an important indicator to evaluate work efficiency of medical care in hospitals. Recently, there have been reports about effects of EMR application on LOS in medical institutions, but they have been mostly based on the overall analysis of a region or a hospital and not of specific clinical departments and diseases or based on longer time periods. Therefore, in this study, we selected four clinical departments and four diseases with the largest number of inpatients from January 2004 to December 2012 in a Chinese 3A general hospital and used an interrupted time-series method by the departments and diseases to analyze the relationship of EMR application and LOS. Through our analyses, we concluded that, under unadjusted condition, LOS were all reduced (P < 0.001) after EMR application in four departments and for four diseases. After adjustment by gender, age or admission condition, LOS still all decreased after EMR application (P < 0.05) regardless of departments or diseases. The trend changes in LOS reversed from increasing to decreasing in the orthopedics department (coefficient: 0.016 to -0.079), the cardiovascular surgery department (coefficient: 0.007 to -0.126) and all departments overall (coefficient: 0.004 to -0.070), as well as for the intervertebral disc disorders (coefficient: 0.026 to -0.068). Furthermore, the decreasing trend gained a larger slope in the cardiology department (coefficient: -0.017 to -0.023), the neurology department (coefficient: -0.012 to -0.043) and for the coronary heart disease (coefficient: -0.010 to -0.018), the ventricular septal defect (coefficient: -0.024 to -0.059), and the cerebral infarction (coefficient: -0.031 to -0.040). Together, these findings indicate that EMR application coincided with a decrease in LOS and may have a contribution to the decrease.

EHR in emergency rooms: exploring the effect of key information components on main complaints

This study characterizes the information components associated with improved medical decision-making in the emergency room (ER). We looked at doctors' decisions to use or not to use information available to them on an electronic health record (EHR) and a Health Information Exchange (HIE) network, and tested for associations between their decision and parameters related to healthcare outcomes and processes. Using information components from the EHR and HIE was significantly related to improved quality of healthcare processes. Specifically, it was associated with both a reduction in potentially avoidable admissions as well as a reduction in rapid readmissions. Overall, the three information components; namely, previous encounters, imaging, and lab results emerged as having the strongest relationship with physicians' decisions to admit or discharge. Certain information components, however, presented an association between the diagnosis and the admission decisions (blood pressure was the most strongly associated parameter in cases of chest pain complaints and a previous surgical record for abdominal pain). These findings show that the ability to access patients' medical history and their long term health conditions (via the EHR), including information about medications, diagnoses, recent procedures and laboratory tests is critical to forming an appropriate plan of care and eventually making more accurate admission decisions.