scholarly journals A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems

2015 ◽  
Vol 06 (03) ◽  
pp. 488-505 ◽  
Author(s):  
P. Fontelo ◽  
E. Rossi ◽  
MJ Ackerman ◽  
S. Marceglia
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Data Exchange ◽  
Home Monitoring ◽  
Healthcare Management ◽  
Health Record ◽  
Active Involvement ◽  
Integration Architecture ◽  
Electronic Health ◽  
Mhealth Apps

SummarySummary Background: Mobile health Applications (mHealth Apps) are opening the way to patients’ responsible and active involvement with their own healthcare management. However, apart from Apps allowing patient’s access to their electronic health records (EHRs), mHealth Apps are currently developed as dedicated “island systems”.Objective: Although much work has been done on patient’s access to EHRs, transfer of information from mHealth Apps to EHR systems is still low. This study proposes a standards-based architecture that can be adopted by mHealth Apps to exchange information with EHRs to support better quality of care.Methods: Following the definition of requirements for the EHR/mHealth App information exchange recently proposed, and after reviewing current standards, we designed the architecture for EHR/mHealth App integration. Then, as a case study, we modeled a system based on the proposed architecture aimed to support home monitoring for congestive heart failure patients. We simulated such process using, on the EHR side, OpenMRS, an open source longitudinal EHR and, on the mHealth App side, the iOS platform.Results: The integration architecture was based on the bi-directional exchange of standard documents (clinical document architecture rel2 – CDA2). In the process, the clinician “prescribes” the home monitoring procedures by creating a CDA2 prescription in the EHR that is sent, encrypted and de-identified, to the mHealth App to create the monitoring calendar. At the scheduled time, the App alerts the patient to start the monitoring. After the measurements are done, the App generates a structured CDA2-compliant monitoring report and sends it to the EHR, thus avoiding local storage.Conclusions: The proposed architecture, even if validated only in a simulation environment, represents a step forward in the integration of personal mHealth Apps into the larger health-IT ecosystem, allowing the bi-directional data exchange between patients and healthcare professionals, supporting the patient’s engagement in self-management and self-care.Citation: Marceglia S, Fontelo P, Rossi E, Ackerman MJ. A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems. Appl Clin Inform 2015;6: 488–505http://dx.doi.org/10.4338/ACI-2014-12-RA-0115

JSON-LD as an Interchange Technology to Facilitate Health Information Exchange

2019 ◽  
Vol 1 (1) ◽  
pp. 66-78
Author(s):  
Daniel L. Kaukinen
Keyword(s):  
Electronic Health Record ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Data Storage ◽  
Information Exchange ◽  
Data Exchange ◽  
Health Record ◽  
Medical Systems ◽  
Record System ◽  
Electronic Health

Sharing information between medical records to form a comprehensive electronic health record leads to effective health management. However, full implementation of an electronic health record has met various barriers including companies wanting to protect their proprietary data storage formats and resisting conversion to a common data exchange format. Through the development of prototype systems, this article investigates the use of JSON-LD as an interpreter to aid in data interchange and data encapsulation. The prototypes demonstrate that JSON-LD can be applied, with nominal code changes, to an existing electronic medical record system employing JSON as a serialization protocol. This article concludes that JSON-LD works as an efficient wrapper that, when well designed, allows for simplified and robust consumption from and serving of data to other JSON-LD enabled medical systems, thereby elevating the usability and effective interconnectivity of new and existing electronic medical record systems.

Securing XML with Role-Based Access Control

2014 ◽  
pp. 334-365 ◽  
Author(s):  
Alberto De la Rosa Algarín ◽  
Steven A. Demurjian ◽  
Timoteus B. Ziminski ◽  
Yaira K. Rivera Sánchez ◽  
Robert Kuykendall
Keyword(s):  
Access Control ◽  
Electronic Health Record ◽  
Information Exchange ◽  
Security Policies ◽  
Health Record ◽  
Role Based Access Control ◽  
Future Trends ◽  
Security Framework ◽  
Electronic Health ◽  
Role Based

Today’s applications are often constructed by bringing together functionality from multiple systems that utilize varied technologies (e.g. application programming interfaces, Web services, cloud computing, data mining) and alternative standards (e.g. XML, RDF, OWL, JSON, etc.) for communication. Most such applications achieve interoperability via the eXtensible Markup Language (XML), the de facto document standard for information exchange in domains such as library repositories, collaborative software development, health informatics, etc. The use of a common data format facilitates exchange and interoperability across heterogeneous systems, but challenges in the aspect of security arise (e.g. sharing policies, ownership, permissions, etc.). In such situations, one key security challenge is to integrate the local security (existing systems) into a global solution for the application being constructed and deployed. In this chapter, the authors present a Role-Based Access Control (RBAC) security framework for XML, which utilizes extensions to the Unified Modeling Language (UML) to generate eXtensible Access Control Markup Language (XACML) policies that target XML schemas and instances for any application, and provides both the separation and reconciliation of local and global security policies across systems. To demonstrate the framework, they provide a case study in health care, using the XML standards Health Level Seven’s (HL7) Clinical Document Architecture (CDA) and the Continuity of Care Record (CCR). These standards are utilized for the transportation of private and identifiable information between stakeholders (e.g. a hospital with an electronic health record, a clinic’s electronic health record, a pharmacy system, etc.), requiring not only a high level of security but also compliance to legal entities. For this reason, it is not only necessary to secure private information, but for its application to be flexible enough so that updating security policies that affect millions of documents does not incur a large monetary or computational cost; such privacy could similarly involve large banks and credit card companies that have similar information to protect to deter identity theft. The authors demonstrate the security framework with two in-house developed applications: a mobile medication management application and a medication reconciliation application. They also detail future trends that present even more challenges in providing security at global and local levels for platforms such as Microsoft HealthVault, Harvard SMART, Open mHealth, and open electronic health record systems. These platforms utilize XML, equivalent information exchange document standards (e.g., JSON), or semantically augmented structures (e.g., RDF and OWL). Even though the primary use of these platforms is in healthcare, they present a clear picture of how diverse the information exchange process can be. As a result, they represent challenges that are domain independent, thus becoming concrete examples of future trends and issues that require a robust approach towards security.

Implementation of Electronic Health Record (EHR) System in the Healthcare Industry

2016 ◽  
pp. 1001-1016
Author(s):  
Robert P Schumaker ◽  
Kavya P. Reganti
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Management ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Health Record ◽  
Healthcare Industry ◽  
Efficient Delivery ◽  
Electronic Health

The purpose of this research is to demonstrate the efficiency of the Electronic Health Record (EHR) software that is adopted in the healthcare industry to provide better patient care. The authors examine the impact of EHRs on the efficient delivery of healthcare services. More specifically, they detail the origin of EHR, its significance in modern healthcare delivery along with the selection and implementation criteria for EHR software. They present a survey on the extent of adoption of EHR by clinicians. They also highlight the challenges and barriers faced by organizations in adopting EHR software such as cost, workflow impact and data security. Finally, the authors contemplate the future of EHR, its role in the implementation of health information exchange and its implementation in the cloud. They conclude that the implementation of EHR in the cloud is an important step towards better health management across the population with the end-goal of better health outcomes.

scholarly journals Management of Laboratory Data and Information Exchange in the Electronic Health Record

2015 ◽  
Vol 139 (3) ◽  
pp. 319-327 ◽  
Author(s):  
Myra L. Wilkerson ◽  
Walter H. Henricks ◽  
William J. Castellani ◽  
Mark S. Whitsitt ◽  
John H. Sinard
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Laboratory Data ◽  
Health Record ◽  
Electronic Health

scholarly journals Search Functionality Within the Electronic Health Record and Health Information Exchange Databases

2020 ◽  
Vol 3 ◽  
Author(s):  
Brandon Gregory ◽  
Jordan Hill ◽  
Titus Schleyer
Keyword(s):  
Electronic Health Record ◽  
Health Information ◽  
Patient Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Record ◽  
Search Function ◽  
Electronic Health

Background and Hypothesis:  In the US today, over 95% of healthcare institutions operate using the electronic health record (EHR). While proven to be a substantial improvement to medical practice, the substantial amount of retained information within those records has made searching the EHR for relevant material difficult and too time consuming. We hypothesize that by providing a search function within the EHR with added capability of collaborative filtration, physicians will be better able to retrieve important patient information and thus provide more efficient care.     Project Methods:   Emergency Department physicians of Sidney & Lois Eskenazi Hospital and Indiana University Health Hospital were recruited to partake in this study based on their use and familiarity of the EHR Cerner and/or Health Information Exchange (HIE) CareWeb Search function. Participants filled out a pre-interview, Likert-scale questionnaire to determine their general impressions of search functions and the frequency with which they were used. Additional insight was obtained during an interview focusing on participants’ previous experiences searching within the EHR/HIE. Participants were then shown a mock-up of potential collaborative filtering integration into CareWeb in order to collect opinions regarding the feature’s usability/practicality, display/format, and a number of suggested terms.    Results:   From the pilot study, current challenges that limit clinician search function use include limited time in clinician workflow, information overload, and inaccurate results. Clinicians are more likely to conduct searches when treating patients who have limited medical history, complex histories, known recent visitations, and/or who have been seen at other institutions. Participants demonstrated interest in a collaborative filtration search feature; they expressed a preference to have the feature recommend five related search terms.    Potential Impact:   The data from this study aims to refine the way healthcare providers search within the EHR/HIE. This will allow healthcare providers to more efficiently extract relevant patient information for improved healthcare delivery and proficient clinician workflow. 

scholarly journals A Proposed Electronic Health Record Content Structure Based on Clinical Organizations Survey

2014 ◽  
Vol 15 (13) ◽  
pp. 5233-5246 ◽  
Author(s):  
Dr. Ayman E. Khedr ◽  
Fahad Kamal Alsheref
Keyword(s):  
Data Structure ◽  
Electronic Health Records ◽  
Electronic Health Record ◽  
Clinical Data ◽  
Data Exchange ◽  
Medical Information System ◽  
Health Record ◽  
Medical Organization ◽  
Health Records ◽  
Electronic Health

Computer systems and communication technologies made a strong and influential presence in the different fields of medicine. The cornerstone of a functional medical information system is the Electronic Health Records (EHR) management system. Several electronic health records systems were implemented in different states with different clinical data structures that prevent data exchange between systems even in the same state. This leads to the important barrier in implementing EHR system which is the lack of standards of EHR clinical data structure. In this paper we made a survey on several in international and Egyptian medical organization for implementing electronic health record systems for finding the best electronic health record clinical data structure that contains all patient’s medical data. We proposed an electronic health record system with a standard clinical data structure based on the international and Egyptian medical organization survey and with avoiding the limitations in the other electronic health record that exists in the survey.

Implementation of Electronic Health Record (EHR) System in the Healthcare Industry

2014 ◽  
Vol 2 (2) ◽  
pp. 57-71 ◽  
Author(s):  
Robert P Schumaker ◽  
Kavya P. Reganti
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Management ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Health Record ◽  
Healthcare Industry ◽  
Electronic Health ◽  
The Impact

The purpose of this research is to demonstrate the efficiency of the Electronic Health Record (EHR) software that is adopted in the healthcare industry to provide better patient care. The authors examine the impact of EHRs on the efficient delivery of healthcare services. More specifically, they detail the origin of EHR, its significance in modern healthcare delivery along with the selection and implementation criteria for EHR software. They present a survey on the extent of adoption of EHR by clinicians. They also highlight the challenges and barriers faced by organizations in adopting EHR software such as cost, workflow impact and data security. Finally, the authors contemplate the future of EHR, its role in the implementation of health information exchange and its implementation in the cloud. They conclude that the implementation of EHR in the cloud is an important step towards better health management across the population with the end-goal of better health outcomes.

EEMI - An Electronic Health Record for Pediatricians

2020 ◽  
pp. 614-628
Author(s):  
Juan C. Lavariega ◽  
Roberto Garza ◽  
Lorena G Gómez ◽  
Victor J. Lara-Diaz ◽  
Manuel J. Silva-Cavazos
Keyword(s):  
Electronic Health Records ◽  
Electronic Health Record ◽  
Data Sharing ◽  
Medical Records ◽  
Data Exchange ◽  
Data Representation ◽  
Health Record ◽  
Health Records ◽  
Health Area ◽  
Electronic Health

The use of paper health records and handwritten prescriptions are prone to preset errors of misunderstanding instructions or interpretations that derive in affecting patients' health. Electronic Health Records (EHR) systems are useful tools that among other functions can assists physicians' tasks such as finding recommended medicines, their contraindications, and dosage for a given diagnosis, filling prescriptions and support data sharing with other systems. This paper presents EEMI, a Children EHR focused on assisting pediatricians in their daily office practice. EEMI functionality keeps the relationships among diagnosis, treatment, and medications. EEMI also calculates dosages and automatically creates prescriptions which can be personalized by the physician. The system also validates patient allergies. This paper also presents the current use of EHRs in Mexico, the Mexican Norm (NOM-024-SSA3-2010), standards for the development of electronic medical records and its relationships with other standards for data exchange and data representation in the health area.

Securing XML with Role-Based Access Control

2016 ◽  
pp. 487-522
Author(s):  
Alberto De la Rosa Algarín ◽  
Steven A. Demurjian ◽  
Timoteus B. Ziminski ◽  
Yaira K. Rivera Sánchez ◽  
Robert Kuykendall
Keyword(s):  
Access Control ◽  
Electronic Health Record ◽  
Information Exchange ◽  
Security Policies ◽  
Health Record ◽  
Role Based Access Control ◽  
Future Trends ◽  
Security Framework ◽  
Electronic Health ◽  
Role Based

Today's applications are often constructed by bringing together functionality from multiple systems that utilize varied technologies (e.g. application programming interfaces, Web services, cloud computing, data mining) and alternative standards (e.g. XML, RDF, OWL, JSON, etc.) for communication. Most such applications achieve interoperability via the eXtensible Markup Language (XML), the de facto document standard for information exchange in domains such as library repositories, collaborative software development, health informatics, etc. The use of a common data format facilitates exchange and interoperability across heterogeneous systems, but challenges in the aspect of security arise (e.g. sharing policies, ownership, permissions, etc.). In such situations, one key security challenge is to integrate the local security (existing systems) into a global solution for the application being constructed and deployed. In this chapter, the authors present a Role-Based Access Control (RBAC) security framework for XML, which utilizes extensions to the Unified Modeling Language (UML) to generate eXtensible Access Control Markup Language (XACML) policies that target XML schemas and instances for any application, and provides both the separation and reconciliation of local and global security policies across systems. To demonstrate the framework, they provide a case study in health care, using the XML standards Health Level Seven's (HL7) Clinical Document Architecture (CDA) and the Continuity of Care Record (CCR). These standards are utilized for the transportation of private and identifiable information between stakeholders (e.g. a hospital with an electronic health record, a clinic's electronic health record, a pharmacy system, etc.), requiring not only a high level of security but also compliance to legal entities. For this reason, it is not only necessary to secure private information, but for its application to be flexible enough so that updating security policies that affect millions of documents does not incur a large monetary or computational cost; such privacy could similarly involve large banks and credit card companies that have similar information to protect to deter identity theft. The authors demonstrate the security framework with two in-house developed applications: a mobile medication management application and a medication reconciliation application. They also detail future trends that present even more challenges in providing security at global and local levels for platforms such as Microsoft HealthVault, Harvard SMART, Open mHealth, and open electronic health record systems. These platforms utilize XML, equivalent information exchange document standards (e.g., JSON), or semantically augmented structures (e.g., RDF and OWL). Even though the primary use of these platforms is in healthcare, they present a clear picture of how diverse the information exchange process can be. As a result, they represent challenges that are domain independent, thus becoming concrete examples of future trends and issues that require a robust approach towards security.

scholarly journals Current Practice in End-of-Residency Handoffs: A Survey of Internal Medicine–Pediatrics Program Directors

2013 ◽  
Vol 5 (1) ◽  
pp. 93-97 ◽  
Author(s):  
Michael J. Donnelly ◽  
Janelle M. Clauser ◽  
Rochelle E. Tractenberg
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Information Exchange ◽  
Best Practice ◽  
Program Directors ◽  
Health Record ◽  
Protected Time ◽  
Formal Systems ◽  
Electronic Health ◽  
Transfer Of Information

Abstract Background End-of-residency outpatient handoffs affect at least 1 million patients per year, yet there is no consensus on best practices. Objective To explore the use of formal systems for end-of-residency clinic handoffs in internal medicine–pediatrics residency (Med-Peds) programs, and their associated categorical internal medicine and pediatrics programs. Methods We surveyed Med-Peds program directors about their programs' system for handing off ambulatory continuity patients. Results Our response rate was 85% (67 of 79 programs). Thirty-one programs (46%) reported having a system for end-of-residency handoffs. Of the 30 that offered detailed information, 22 (73%) formally introduced the program to residents, 12 (40%) standardized the handoff, and 14 (47%) used multiple methods for information exchange, with the electronic health record and oral transfer of information (15 of 30, 50%) the most common. Six programs (20%) indicated they did not offer residents protected time to complete end-of-residency handoffs, and 13 programs (43%) did not identify a specific postgraduate year level for residents to whom patients were handed off. Programs were more likely to have a system for end-of-residency handoffs if another categorical program at their institution also had one (P < .001). Conclusions Fewer than half of responding Med-Peds programs have outpatient handoff systems in place. Inclusion of end-of-residency handoff information in the electronic health record may represent a best practice that has the potential of enhancing continuity and safety of care for patients in resident continuity clinics.

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