Audit Mechanisms in Electronic Health Record Systems

2012 ◽  
Vol 3 (2) ◽  
pp. 23-42 ◽  
Author(s):  
Jason King ◽  
Ben Smith ◽  
Laurie Williams
Keyword(s):  
Electronic Health Record ◽  
Open Source ◽  
Health Information ◽  
Black Box ◽  
Qualitative Assessment ◽  
Test Cases ◽  
Health Record ◽  
Protected Health Information ◽  
Electronic Health ◽  
Software Intensive

Inadequate audit mechanisms may result in undetected misuse of data in software-intensive systems. In the healthcare domain, electronic health record (EHR) systems should log the creating, reading, updating, or deleting of privacy-critical protected health information. The objective of this paper is to assess electronic health record audit mechanisms to determine the current degree of auditing for non-repudiation and to assess whether general audit guidelines adequately address non-repudiation. The authors analyzed the audit mechanisms of two open source EHR systems, OpenEMR and Tolven eCHR, and one proprietary EHR system. The authors base the qualitative assessment on a set of 16 general auditable events and 58 black-box test cases for specific auditable events. The authors find that OpenEMR satisfies 62.5% of the general criteria and passes 63.8% of the black-box test cases. Tolven eCHR and the proprietary EHR system each satisfy less than 19% of the general criteria and pass less than 11% of the black-box test cases.

scholarly journals Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study (Preprint)

2017 ◽  
Author(s):  
Naomi Muinga ◽  
Steve Magare ◽  
Jonathan Monda ◽  
Onesmus Kamau ◽  
Stuart Houston ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Open Source ◽  
Health Information ◽  
Health Care Facilities ◽  
Health Record ◽  
Record System ◽  
Care Facilities ◽  
Electronic Health

BACKGROUND The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. OBJECTIVE We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. METHODS We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. RESULTS This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. CONCLUSIONS Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa.

scholarly journals Open MRS softwares: effective approaches in management of patients' health information

2017 ◽  
Vol 4 (11) ◽  
pp. 3948
Author(s):  
Azadeh Bashiri ◽  
Marjan Ghazisaeedi
Keyword(s):  
Electronic Health Record ◽  
Open Source ◽  
Health Information ◽  
Health Record ◽  
Web Based ◽  
Patient Health ◽  
Technical Architecture ◽  
Electronic Health ◽  
Mozilla Firefox

Today, the complexities of health issues require technologies to improve the quality of health care and maintain healthy individuals. Open source softwares such as OpenMRS are the basis for developing electronic health record systems to manage patient health information. Data model, API, and Web-based application are the three main parts of OpenMRS technical architecture. The core of the Open MRS software includes a web-based application and a number of open source softwares such as My SQL, Mozilla Firefox and Hyper net. These softwares use standards such as XML and X-Form to exchange and display data and enhance collaboration with other systems. Also, they can be manipulated and searched using SQL. Considering the high potential of OpenMRS in reducing the cost of implementation and development of electronic health record systems in developing countries, they can be used to manage information of patients and improve the quality of health services.

Assessing HIPAA Compliance of Open Source Electronic Health Record Applications

2021 ◽  
Vol 15 (2) ◽  
pp. 181-195
Author(s):  
Hossain Shahriar ◽  
Hisham M. Haddad ◽  
Maryam Farhadi
Keyword(s):  
Electronic Health Record ◽  
Open Source ◽  
Medical Decision ◽  
Patient Treatment ◽  
Health Record ◽  
Technical Requirements ◽  
Patient Health ◽  
Treatment Plans ◽  
Electronic Health ◽  
Quality In Healthcare

Electronic health record (EHR) applications are digital versions of paper-based patient health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process. The goal of this paper is to identify HIPAA technical requirements, evaluate two open source EHR applications (OpenEMR and OpenClinic) for security vulnerabilities using two open-source scanner tools (RIPS and PHP VulnHunter), and map the identified vulnerabilities to HIPAA technical requirements.

scholarly journals Semantic computational analysis of anticoagulation use in atrial fibrillation from real world data

2019 ◽  
Author(s):  
Daniel M. Bean ◽  
James Teo ◽  
Honghan Wu ◽  
Ricardo Oliveira ◽  
Raj Patel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Natural Language Processing ◽  
Natural Language ◽  
Electronic Health Record ◽  
Open Source ◽  
Language Processing ◽  
Risk Scores ◽  
Free Text ◽  
Health Record ◽  
Electronic Health

AbstractAtrial fibrillation (AF) is the most common arrhythmia and significantly increases stroke risk. This risk is effectively managed by oral anticoagulation. Recent studies using national registry data indicate increased use of anticoagulation resulting from changes in guidelines and the availability of newer drugs.The aim of this study is to develop and validate an open source risk scoring pipeline for free-text electronic health record data using natural language processing.AF patients discharged from 1st January 2011 to 1st October 2017 were identified from discharge summaries (N=10,030, 64.6% male, average age 75.3 ± 12.3 years). A natural language processing pipeline was developed to identify risk factors in clinical text and calculate risk for ischaemic stroke (CHA2DS2-VASc) and bleeding (HAS-BLED). Scores were validated vs two independent experts for 40 patients.Automatic risk scores were in strong agreement with the two independent experts for CHA2DS2-VASc (average kappa 0.78 vs experts, compared to 0.85 between experts). Agreement was lower for HAS-BLED (average kappa 0.54 vs experts, compared to 0.74 between experts).In high-risk patients (CHA2DS2-VASc ≥2) OAC use has increased significantly over the last 7 years, driven by the availability of DOACs and the transitioning of patients from AP medication alone to OAC. Factors independently associated with OAC use included components of the CHA2DS2-VASc and HAS-BLED scores as well as discharging specialty and frailty. OAC use was highest in patients discharged under cardiology (69%).Electronic health record text can be used for automatic calculation of clinical risk scores at scale. Open source tools are available today for this task but require further validation. Analysis of routinely-collected EHR data can replicate findings from large-scale curated registries.

scholarly journals Implementation of RSA 2048-bit and AES 256-bit with Digital Signature for Secure Electronic Health Record Application

2016 ◽  
Vol 10 (2) ◽  
pp. 63
Author(s):  
Mohamad Ali Sadikin ◽  
Rini Wisnu Wardhani
Keyword(s):  
Electronic Health Record ◽  
Digital Signature ◽  
Black Box ◽  
Encryption Algorithm ◽  
Health Record ◽  
Electronic Documents ◽  
Verification Scheme ◽  
Java Programming ◽  
Black Box Testing ◽  
Electronic Health

This research addresses the implementation of encryption and digital signature technique for electronic health record to prevent cybercrime such as robbery, modification and unauthorised access. In this research, RSA 2048-bit algorithm, AES 256-bit and SHA 256 will be implemented in Java programming language. Secure Electronic Health Record Information (SEHR) application design is intended to combine given services, such as confidentiality, integrity, authentication, and nonrepudiation. Cryptography is used to ensure the file records and electronic documents for detailed information on the medical past, present and future forecasts that have been given only to the intended patients. The document will be encrypted using an encryption algorithm based on NIST Standard. In the application, there are two schemes, namely the protection and verification scheme. This research uses black-box testing and whitebox testing to test the software input, output, and code without testing the process and design that occurs in the system.We demonstrated the implementation of cryptography in SEHR. The implementation of encryption and digital signature in this research can prevent archive thievery.

Electronic health record use among cancer patients: Insights from the Health Information National Trends Survey

2017 ◽  
Vol 25 (1) ◽  
pp. 83-90 ◽  
Author(s):  
Yulia A Strekalova
Keyword(s):  
Electronic Health Records ◽  
Electronic Health Record ◽  
Cancer Patients ◽  
Health Information ◽  
Information Seeking ◽  
Health Record ◽  
Online Information ◽  
Health Records ◽  
Electronic Health ◽  
National Trends

Over 90% of US hospitals provide patients with access to e-copy of their health records, but the utilization of electronic health records by the US consumers remains low. Guided by the comprehensive information-seeking model, this study used data from the National Cancer Institute’s Health Information National Trends Survey 4 (Cycle 4) and examined the factors that explain the level of electronic health record use by cancer patients. Consistent with the model, individual information-seeking factors and perceptions of security and utility were associated with the frequency of electronic health record access. Specifically, higher income, prior online information seeking, interest in accessing health information online, and normative beliefs were predictive of electronic health record access. Conversely, poorer general health status and lack of health care provider encouragement to use electronic health records were associated with lower utilization rates. The current findings provide theory-based evidence that contributes to the understanding of the explanatory factors of electronic health record use and suggest future directions for research and practice.

Sign in / Sign up

Export Citation Format

Share Document