When most patients visit physicians in a clinic or a hospital, they are asked about their medical history and related medical tests’ results which might not exist or might simply have been lost over time. In emergency situations, many patients suffer or sadly die because of lack of pertinent medical information. Patient’s Health information (PHI) saved by Electronic Medical Record (EMR) could be accessible only by a hospital using their EMR system. Furthermore, Personal Health Record (PHR) information cannot be solely relied on since it is controlled solely by patients. This paper introduces a novel framework for accessing, sharing, and controlling the medical records for patients and their physicians globally, while patients’ PHI are securely stored and their privacy is taken into consideration. Based on the framework, a proof of concept prototype is implemented. Preliminary performance evaluation results indicate the validity and viability of the proposed framework.
المركز الرابع لمشاريع تحدي الامراض المزمنة
في مبادرة التحول الرقمي fekra_tech
وهو عبارة عن توضيف مكائن الفحص الذاتي للكشف عن المرضي المعرضين للاصابة بالسكري
fekratech.gov.sa
@NDU_KSA
IMPLEMENTING ELECTRONIC HEALTH RECORDS IN NEW ZEALAND: A CRITICAL APPRAISAL O...hiij
New Zealand health sector has increasing demands in theageing population and ongoing inflation of medical costs. These demands are growing, and the importance of technology could optimise the healthcare sector performance. Advancement in technology drives Electronic Health Records
implementation to add substantial value to health delivery systems. The investment and promotion of health informationinfrastructure have positioned New Zealand as a world leader in the field of primary care sector. Factors such as organisation structure, culture, leadership and workflow design are important to achieving successful implementation of Electronic Health Records. This review intends to critically appraise the advantages of EHRs over paper-based records (PBRs). It outlines the measures introduced by Ministry of Health to implement EHRs across the health sector in New Zealand. Furthermore, the review will provide an international comparison in implementing EHRs with that of New Zealand.
المركز الرابع لمشاريع تحدي الامراض المزمنة
في مبادرة التحول الرقمي fekra_tech
وهو عبارة عن توضيف مكائن الفحص الذاتي للكشف عن المرضي المعرضين للاصابة بالسكري
fekratech.gov.sa
@NDU_KSA
IMPLEMENTING ELECTRONIC HEALTH RECORDS IN NEW ZEALAND: A CRITICAL APPRAISAL O...hiij
New Zealand health sector has increasing demands in theageing population and ongoing inflation of medical costs. These demands are growing, and the importance of technology could optimise the healthcare sector performance. Advancement in technology drives Electronic Health Records
implementation to add substantial value to health delivery systems. The investment and promotion of health informationinfrastructure have positioned New Zealand as a world leader in the field of primary care sector. Factors such as organisation structure, culture, leadership and workflow design are important to achieving successful implementation of Electronic Health Records. This review intends to critically appraise the advantages of EHRs over paper-based records (PBRs). It outlines the measures introduced by Ministry of Health to implement EHRs across the health sector in New Zealand. Furthermore, the review will provide an international comparison in implementing EHRs with that of New Zealand.
Dr Sanjoy Sanyal wrote this article when he was doing his Masters in Royal College of Surgeons of Edinburgh, University of Bath, United Kingdom.
It traces the origin of the term and discipline called 'Medical Informatics'; describes its evolution and mentions its current healthcare applicability and academic status.
It is fundamental towards understanding today's Information Explosion and its digital implications in all work atmospheres.
Today Dr Sanjoy Sanyal is Professor and Course Director of Neuroscience and FCM-III in Caribbean.
Personal Health Record Management SystemYogeshIJTSRD
Good health is one of the most valuable resources for a human being. Large scale technological advancements have significantly improved human health by a large margin. But there are still several diseases whose symptoms are highly painful and debilitating for a patient. The doctor is in charge of facilitating an effective diagnosis of the patients illness and providing relief to the patient through various medications. For this purpose, the doctor has at his disposal repository of information in the form of PHR or Public Health Records which can be utilized for querying the symptoms experienced by the patient. Sometimes the Medical Institute does not have the PHR with the exact parameters and symptoms described by the patient. Due to the deficiency in the PHR database, the doctor can employ the use of a data aggregator or vendor for fulfilling the requirement from other medical institutions. The problem in this approach is that there is a lack of trust between the medical Institutions and the data aggregators, as PHR can contain sensitive and personally identifiable information that cannot be shared easily. Therefore, this Publication details the implementation of an effective access control mechanism through the use of the distributed blockchain framework along with the introduction of K means clustering and entropy analysis catalyst by the artificial neural network to alleviate the trust issues. Extensive experimentation on the proposed methodology has confirmed its superiority in comparison to the conventional approaches. Chinmayee Y. Raut | Bushra R. Inamdar | Prof. R. G. Yelalwar "Personal Health Record Management System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39900.pdf Paper URL: https://www.ijtsrd.com/engineering/computer-engineering/39900/personal-health-record-management-system/chinmayee-y-raut
Medical Record Audit in Clinical Nursing Units in Tertiary Hospitaliosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
OSFair2017 Training | Big data and evidence-based medicine in GreeceOpen Science Fair
Lefteris Thireos talks about big data and evidence-based medicine in Greece.
Workshop title: Datathons in Evidence-Based Medicine: Applying Open Science Principles to Support Cross-Disciplinary Education and Research
Workshop abstract:
In this interactive workshop, we explore how open science enables “datathons”, events that bring together teams of researchers to work together on unanswered clinical questions. We begin by outlining the datathon model and describe our experiences in holding these events internationally. We then offer an opportunity to participate in an interactice exercise, working together to analyse highly detailed information collected from patients admitted to critical care units at a large tertiary care hospital. Participants will learn about open science in clinical research and gain an overview of MIMIC-III, a freely-available critical care dataset collected from over >50,000 hospital stays.
DAY 2 - PARALLEL SESSION 3
http://opensciencefair.eu/training/parallel-day-2-1/datathons-in-evidence-based-medicine-applying-open-science-principles-to-support-cross-disciplinary-education-and-research
Incorporating emerging technologies with independent pharmacy careCody Midlam
Program Description:
This program will identify emerging technologies affecting the practice of pharmacy in a transitional healthcare delivery system, with a focus on those technologies that increase interconnectivity of electronic health records, tools to improve pharmacist-patient communication, and tools that aide in drug therapy monitoring.
Objectives:
1. Chart the data flow to and from electronic health records and what pharmacists can expect in the future
2. Identify mobile health devices and applications (apps) to monitor blood pressure, blood glucose, and other patient-centric labs
3. Differentiate between historical, current, and future programs to aide in medication adherence and compliance
4. Distinguish which technologies enable the independent pharmacy to further enmesh itself within existing healthcare systems
Can patient summaries help in the emergency department?
What are the challenges? What are the opportunities?
How can we overcome barriers?
Can patient summaries help in Health information exchange?
THE 4 R’S – REASON, REDCAP, REVIEW AND RESEARCH - IN A LARGE HEALTHCARE ORGAN...hiij
This paper outlines the journey of a large Australian academic health service in relation to the acquisition,installation and roll out of the REDCap platform (RCP) for the betterment of clinical review (clinical audit) and research data collection. The main aims of the acquisition of the platform were to facilitate data
collection and management for audit and research across the organization in a more sustainable way than had previously been possible. We found the platform to be easily installed and maintained. There was rapid uptake of the platform by a range of health service stakeholders across the audit, research and operational domains. We were also able to successfully integrate data from our corporate clinical data environment,
The REASON Discovery Platform R (REASON) into selected REDCap “applications” using the Dynamic Data Pull (DDP) functionality it provides. In summary the acquisition and installation of REDCap at our health service has been hugely successful and has provided a great facility for use by a large number of organizational stakeholders going forwards into the future.
Predictive comparative qsar analysis of as 5 nitrofuran-2-yl derivatives myco...hiij
Antitubercular activity of 5-nitrofuran-2-yl Deriva
tives series were subjected to Quantitative Struc
ture
Activity Relationship (QSAR) Analysis with an effo
rt to derive and understand a correlation between t
he
biological activity as response variable and differ
ent molecular descriptors as independent variables.
QSAR models are built using 40 molecular descriptor
dataset. Different statistical regression express
ions
were got using Partial Least Squares (PLS) ,Multip
le Linear Regression (MLR) and Principal Component
Regression (PCR) techniques. The among these techni
que, Partial Least Square Regression (PLS)
technique has shown very promising result as compar
ed to MLR technique A QSAR model was build by a
training set of 30 molecules with correlation coe
fficient (
) of 0.8484 , significant cross validated
correlation coefficient (
) is 0.0939,
is 48.5187,
for external test set (
_
)
is -0.5604,
coefficient of correlation of predicted data set
( _
) is 0.7252 and degree of freedom is 26 by
Partial Least Squares Regression technique.
Dr Sanjoy Sanyal wrote this article when he was doing his Masters in Royal College of Surgeons of Edinburgh, University of Bath, United Kingdom.
It traces the origin of the term and discipline called 'Medical Informatics'; describes its evolution and mentions its current healthcare applicability and academic status.
It is fundamental towards understanding today's Information Explosion and its digital implications in all work atmospheres.
Today Dr Sanjoy Sanyal is Professor and Course Director of Neuroscience and FCM-III in Caribbean.
Personal Health Record Management SystemYogeshIJTSRD
Good health is one of the most valuable resources for a human being. Large scale technological advancements have significantly improved human health by a large margin. But there are still several diseases whose symptoms are highly painful and debilitating for a patient. The doctor is in charge of facilitating an effective diagnosis of the patients illness and providing relief to the patient through various medications. For this purpose, the doctor has at his disposal repository of information in the form of PHR or Public Health Records which can be utilized for querying the symptoms experienced by the patient. Sometimes the Medical Institute does not have the PHR with the exact parameters and symptoms described by the patient. Due to the deficiency in the PHR database, the doctor can employ the use of a data aggregator or vendor for fulfilling the requirement from other medical institutions. The problem in this approach is that there is a lack of trust between the medical Institutions and the data aggregators, as PHR can contain sensitive and personally identifiable information that cannot be shared easily. Therefore, this Publication details the implementation of an effective access control mechanism through the use of the distributed blockchain framework along with the introduction of K means clustering and entropy analysis catalyst by the artificial neural network to alleviate the trust issues. Extensive experimentation on the proposed methodology has confirmed its superiority in comparison to the conventional approaches. Chinmayee Y. Raut | Bushra R. Inamdar | Prof. R. G. Yelalwar "Personal Health Record Management System" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-3 , April 2021, URL: https://www.ijtsrd.com/papers/ijtsrd39900.pdf Paper URL: https://www.ijtsrd.com/engineering/computer-engineering/39900/personal-health-record-management-system/chinmayee-y-raut
Medical Record Audit in Clinical Nursing Units in Tertiary Hospitaliosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
OSFair2017 Training | Big data and evidence-based medicine in GreeceOpen Science Fair
Lefteris Thireos talks about big data and evidence-based medicine in Greece.
Workshop title: Datathons in Evidence-Based Medicine: Applying Open Science Principles to Support Cross-Disciplinary Education and Research
Workshop abstract:
In this interactive workshop, we explore how open science enables “datathons”, events that bring together teams of researchers to work together on unanswered clinical questions. We begin by outlining the datathon model and describe our experiences in holding these events internationally. We then offer an opportunity to participate in an interactice exercise, working together to analyse highly detailed information collected from patients admitted to critical care units at a large tertiary care hospital. Participants will learn about open science in clinical research and gain an overview of MIMIC-III, a freely-available critical care dataset collected from over >50,000 hospital stays.
DAY 2 - PARALLEL SESSION 3
http://opensciencefair.eu/training/parallel-day-2-1/datathons-in-evidence-based-medicine-applying-open-science-principles-to-support-cross-disciplinary-education-and-research
Incorporating emerging technologies with independent pharmacy careCody Midlam
Program Description:
This program will identify emerging technologies affecting the practice of pharmacy in a transitional healthcare delivery system, with a focus on those technologies that increase interconnectivity of electronic health records, tools to improve pharmacist-patient communication, and tools that aide in drug therapy monitoring.
Objectives:
1. Chart the data flow to and from electronic health records and what pharmacists can expect in the future
2. Identify mobile health devices and applications (apps) to monitor blood pressure, blood glucose, and other patient-centric labs
3. Differentiate between historical, current, and future programs to aide in medication adherence and compliance
4. Distinguish which technologies enable the independent pharmacy to further enmesh itself within existing healthcare systems
Can patient summaries help in the emergency department?
What are the challenges? What are the opportunities?
How can we overcome barriers?
Can patient summaries help in Health information exchange?
THE 4 R’S – REASON, REDCAP, REVIEW AND RESEARCH - IN A LARGE HEALTHCARE ORGAN...hiij
This paper outlines the journey of a large Australian academic health service in relation to the acquisition,installation and roll out of the REDCap platform (RCP) for the betterment of clinical review (clinical audit) and research data collection. The main aims of the acquisition of the platform were to facilitate data
collection and management for audit and research across the organization in a more sustainable way than had previously been possible. We found the platform to be easily installed and maintained. There was rapid uptake of the platform by a range of health service stakeholders across the audit, research and operational domains. We were also able to successfully integrate data from our corporate clinical data environment,
The REASON Discovery Platform R (REASON) into selected REDCap “applications” using the Dynamic Data Pull (DDP) functionality it provides. In summary the acquisition and installation of REDCap at our health service has been hugely successful and has provided a great facility for use by a large number of organizational stakeholders going forwards into the future.
Predictive comparative qsar analysis of as 5 nitrofuran-2-yl derivatives myco...hiij
Antitubercular activity of 5-nitrofuran-2-yl Deriva
tives series were subjected to Quantitative Struc
ture
Activity Relationship (QSAR) Analysis with an effo
rt to derive and understand a correlation between t
he
biological activity as response variable and differ
ent molecular descriptors as independent variables.
QSAR models are built using 40 molecular descriptor
dataset. Different statistical regression express
ions
were got using Partial Least Squares (PLS) ,Multip
le Linear Regression (MLR) and Principal Component
Regression (PCR) techniques. The among these techni
que, Partial Least Square Regression (PLS)
technique has shown very promising result as compar
ed to MLR technique A QSAR model was build by a
training set of 30 molecules with correlation coe
fficient (
) of 0.8484 , significant cross validated
correlation coefficient (
) is 0.0939,
is 48.5187,
for external test set (
_
)
is -0.5604,
coefficient of correlation of predicted data set
( _
) is 0.7252 and degree of freedom is 26 by
Partial Least Squares Regression technique.
A risk assessment is nothing more than a careful examination of what, in your work or activities, could cause harm to people, so that you can weigh up whether you have taken enough precautions or should do more to prevent harm. The aim is to make sure that no one gets hurt or becomes ill. Accidents and ill health can ruin lives, and affect your business too. See more at http://greenwgroup.ae/
Survey of open source health information systemshiij
Due to the Health Information Technology for Economic and Clinical Health Act (HITECH), the US
medical industry has been given a directive to transition to electronic health records. Electronic Health
Records will enhance efficiency and quality of patient care. In this paper, open-source health information
systems are surveyed.These systems include electronic medical records, electronic health records and
personal health record systems. Their functionality, implementation technologies used, and security
features are discussed.
Pg2 Beginning in 1991, the IOM (which stands for the Institute o.docxrandymartin91030
Pg2 Beginning in 1991, the IOM (which stands for the Institute of Medicine of the National Academies) sponsored studies and created reports that led the way toward the concepts we have in place today for electronic health records. Originally, the IOM called them computer-based patient records.1 During their evolution, the EHR have had many other names, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. All of these names referred to essentially the same thing, which in 2003, the IOM renamed as the electronic health records, or EHR.
Note: EHR
The acronym EHR is commonly used as shorthand for Electronic Health Records, and will be used in the remainder of this book.
Institute of Medicine (IOM)
The IOM report2 put forth a set of eight core functions that an EHR should be capable of performing:
Health information and data
This function provides a defined data set that includes such items as medical and nursing diagnoses, a medication list, allergies, demographics, clinical narratives, and laboratory test results. Further, it provides improved access to information needed by care providers when they need it.
Result management
Computerized results can be accessed more easily (than paper reports) by the provider at the time and place they are needed.
· Reduced lag time allows for quicker recognition and treatment of medical problems.
· The automated display of previous test results makes it possible to reduce redundant and additional testing.
· Having electronic results can allow for better interpretation and for easier detection of abnormalities, thereby ensuring appropriate follow-up.
· Access to electronic consults and patient consents can establish critical links and improve care coordination among multiple providers, as well as between provider and patient
Order management
Computerized provider order entry (CPOE) systems can improve workflow processes by eliminating lost orders and ambiguities caused by illegible handwriting, generating related orders automatically, monitoring for duplicate orders, and reducing the time required to fill orders.
· CPOE systems for medications reduce the number of errors in medication dose and frequency, drug allergies, and drug–drug interactions.
· The use of CPOE, in conjunction with an EHR, also improves clinician productivity.
Decision Support
Computerized decision support systems include prevention, prescribing of drugs, diagnosis and management, and detection of adverse events and disease outbreaks.
· Computer reminders and prompts improve preventive practices in areas such as vaccinations, breast cancer screening, colorectal screening, and cardiovascular risk reduction.
Electronic communication and connectivity
Electronic communication among care partners can enhance patient safety and quality of care, especially for patients who have multiple providers in multiple settings that must coordinate care plans.
· Electronic co.
64 journal of law, medicine & ethicsDreams and Nightmare.docxevonnehoggarth79783
64 journal of law, medicine & ethics
Dreams and
Nightmares:
Practical and
Ethical Issues
for Patients and
Physicians Using
Personal Health
Records
Matthew Wynia and Kyle Dunn
Introduction and Definitions
The term “Electronic Health Records” (EHR) means
something different to each of the stakeholders in
health care, but it always seems to carry a degree of
emotional baggage. Increasingly, EHRs are advert-
ized as a nearly unmitigated good that will transform
medical care, improve safety and efficiency, allow
better patient engagement, and open the door to an
era of cheap, effective, timely, and patient-centered
care.1 Indeed, for some EHR proponents the ben-
efits of adopting them are so obvious that adoption
has become an end in itself.2 But for others — and
especially for a number of skeptical practitioners and
patients — EHR is a code word that portends the cor-
porate transformation of health care delivery, the loss
of patient privacy, the demand that patients bear more
responsibility in health care, and the unreflective take-
over of the health care system by people who do not
understand medical care or how health care relation-
ships unfold.3
For our purposes, we will consider EHRs impar-
tially, as a set of tools that can be used for a variety of
purposes. We define EHRs broadly as any electronic
means of storing and transferring health-related
information. We exclude from this definition the use
of the telephone and fax, arguably precursors to the
electronic means of data exchange now available. Like
face-to-face and paper-based interactions, the tele-
phone and fax are generally limited to two people.
Breaches of phone line security, while possible and
perhaps even frequent, are unlikely to affect thou-
sands of people at once.
In this paper, we examine the development of a new
set of EHR tools, Personal Health Records (PHRs).
PHRs may be variously defined (Table I) and have sev-
eral potential functional and payment models (Table
II), but the general aim of all PHRs is to increase
patients’ access to and sense of ownership over their
health care information. According to the Markle
Foundation, the advent of PHRs “represents a transi-
tion from a patient record that is physician-centered
to one that is patient-centered, prospective, interac-
Matthew Wynia, M.D., M.P.H., is the Director of the In-
stitute for Ethics at the American Medical Association and a
Clinical Assistant Professor at the University of Chicago. He
received his M.D. from the Oregon Health and Science Univer-
sity in Portland, Oregon and his M.P.H. from Harvard Uni-
versity School of Public Health in Boston, MA. Kyle Dunn,
M.H.S., was a Research Assistant at the Institute for Ethics
at the American Medical Association and is now a Ph.D. can-
didate in the Department of Health Policy and Management
at the Johns Hopkins Bloomberg School of Public Health. He
received a B.S. in Molecular, Cellular and Developmental Bi-
ology .
Running head MEDICAL TECHNOLOGY 1MEDICA.docxcowinhelen
Running head: MEDICAL TECHNOLOGY 1
MEDICAL TECHNOLOGY 6
Medical Technology
Felicia Jones
04/26/2017
Introduction
Health Information Technology (HIT) involves the use of a digital format to store, distribute, and analyze health information. HIT is used between doctor-patient communications to improve the patient’s care. The IT professionals working in the HIT are involved in the technical side of managing health information using software and hardware to manage patients’ data. The professionals provide support to the Electronic Health Records (EHRs) management and other professionals to ascertain accurate dissemination of medical records adhering to HIPAA and HITECH rules and regulations (McInnes, 2016).
Health and financial benefits of implementing EHR
Improved health care and convenience
Access to the patients’ records is easy even in remote locations which ease the quality of care in the case of emergencies. Having all the information located at a central place makes decision making easy. Use of EHRs helps different hospitals and laboratories to access a patient’s medical history
Improved Patient participation
EHRs makes it possible for health professionals to give the patients all their medical evaluations. The providers can provide follow-up information such as web resources and self-care instructions which aid in improving the quality of health care.
Improved diagnostics and patient outcomes
With an accurate medical history of a patient, the medical professionals can check for any allergies, prior treatments which help during the treatment process. The frequency of medical errors during diagnosis. Qualified EHR checks for problems when a new medication is given to the patient and alerting the doctor in advance in the case of any potential threats. In regard to national disasters where casualties forget their medical history, EHR helps quick retrieval of their history and aid in saving their lives.
Time and cost savings
Use of EHRs assists in reducing duplication of testing which saves on the cost of conducting laboratory tests. Moreover, the administrative expenses as a result of filling of numerous patients paperwork. As a consequence of the use of EHRs, there is reduced transcription, storage, and chart-pull costs. The use of electronic prescribing reduces medical errors (Goldberg, & Feng, 2012).
Cost of implementing and maintaining EHR
Setting up an EHR system up and running is quite expensive. Some of the expenses associated with establishing the system are the required hardware and software, installation, training of the IT professionals and ongoing maintenance. There are other costs such as over-time-pay for the providers. Taking a primary care facility with five physicians, the cost of setting up an EHR system is $162,000 and maintenance cost of $ 85,500 within the first year. The IT professionals operating the EHRs needed 611 hours of training whereas each physician require ...
Eysenbach AMIA Keynote: From Patient Needs to Personal Health ApplicationsGunther Eysenbach
AMIA Spring Conference, May 29th-31st, 2008, Phoenix/AZ. PHR Track Keynote covers: An international perspective on the importance of PHR/PHA development & research; patient needs (and other drivers of Personal Health Records); Emerging technological trends, with an emphasis on what Eysenbach calls PHR 2.0 – impact of Web 2.0 approaches e.g. to reduce attrition in ehealth applications
Eysenbach: Personal Health Applications and Personal Health RecordsGunther Eysenbach
Keynote talk at the AMIA Spring Conference in the PHR track (Personal Health Records), focussing on international develoments and a new paradigm which I call PHR 2.0
A framework for secure healthcare systems based on big data analytics in mobi...ijasa
In this paper we introduce a framework for Healthcare Information Systems (HISs) based on big data
analytics in mobile cloud computing environments. This framework provides a high level of integration,
interoperability, availability and sharing of healthcare data among healthcare providers, patients, and
practitioners. Electronic Medical Records (EMRs) of patients dispersed among different Care Delivery
Organizations (CDOs) are integrated and stored in the Cloud storage area, this creates an Electronic
Health Records (EHRs) for each patient. Mobile Cloud allows fast Internet access and provision of EHRs
from anywhere and at any time via different platforms. Due to the massive size of healthcare data, the
exponential increase in the speed in which this data is generated and the complexity of healthcare data
type, the proposed framework employs big data analytics to find useful insights that help practitioners take
critical decisions in the right time. In addition, our proposed framework applies a set of security
constraints and access control that guarantee integrity, confidentiality, and privacy of medical information.
We believe that the proposed framework paves the way for a new generation of lower cost, more efficient
healthcare systems.
Towards EHR Interoperability in Tanzania Hospitals : Issues, Challenges and O...IJCSEA Journal
This study aimed at identifying the issue, challenges and opportunities from the health consumers in Tanzania towards interoperability of electronic health records. Reaching that level of seamless data sharing among Hospitals needs the cooperation of all stakeholders especially the health consumer whose data are the ones to be shared. Without their acceptance that means there is nothing to share. Recognizing that we conducted a study in Tanzania to identify the challenges, issues and opportunities towards health information exchange through interoperable EHRs. The study was conducted in three major cities of Tanzania to identify the security, privacy and confidentiality issues of information sharing together with related challenges to data sharing. This was in order to come up with a clear picture of how to implement some EHRs that will be trusted by health consumers. The participants (n=240) were surveyed on computer usage, EHRs knowledge, demographics, security and privacy issues. A total of 200 surveys were completed and returned (83.3% response rate). Among them 67.5% were women, 62.6% had not heard of EHRs, 73% were highly concerned about the privacy and security of their information. 75% believed that introduction of various security mechanisms will make EHRs more secure and thus better. We conducted a number of chi-square tests (p<0.05) and we realized that there was a strong relationship among the variable of age, computer use, EHRs knowledge and the concerns for privacy and security. The study also showed that there was just a small difference of 8.5% between those people who think EHRs are safer than paper records and those who think otherwise. The general observation of the study was that in order to make EHRs successful in our Hospitals then the issue of security, and health consumer involvement were they two key towards the road of successful EHRs in our hospitals practices and that will make consumers more willing to allow their records to be shared among different health organizations. So besides the issues identified, this study helped us to identify the key requirements which will be implemented in our proposed framework
Similar to A novel framework for electronic global (20)
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
HEALTH DISPARITIES: DIFFERENCES IN VETERAN AND NON-VETERAN POPULATIONS USING ...hiij
Introduction: This study investigated self-reported health status, health screenings, vision problems, and
vaccination rates among veteran and non-veteran groups to uncover health disparities that are critical for
informed health system planning for veteran populations.
Methods: Using public-use data from the National Health Interview Survey (2015-2018), this study adopts
an ecologic cross-sectional approach to conduct an in-depth analysis and visualization of the data assisted
by Generative AI, specifically ChatGPT-4. This integration of advanced AI tools with traditional
epidemiological principles enables systematic data management, analysis, and visualization, offering a
nuanced understanding of health dynamics across demographic segments and highlighting disparities
essential for veteran health system planning.
Findings: Disparities in self-reports of health outcomes, health screenings, vision problems, and
vaccination rates were identified, emphasizing the need for targeted interventions and policy adjustments.
Conclusion: Insights from this study could inform health system planning, using epidemiological data
assessment to suggest enhancements for veteran healthcare delivery. These findings highlight the value of
integrating Generative AI with epidemiological analysis in shaping public health policy and health
planning.
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
BRIEF COMMENTARY: USING A LOGIC MODEL TO INTEGRATE PUBLIC HEALTH INFORMATICS ...hiij
The COVID-19 pandemic has been a watershed moment in public health surveillance, highlighting the
crucial role of data-driven insights in informing health actions and policies. Revisiting key concepts—
public health, epidemiology in public health practice, public health surveillance, and public health
informatics—lays the foundation for understanding how these elements converge to create a robust public
health surveillance system framework. Especially during the COVID-19 pandemic, this integration was
exemplified by the WHO efforts in data dissemination and the subsequent global response. The role of
public health informatics emerged as instrumental in this context, enhancing data collection, management,
analysis, interpretation, and dissemination processes. A logic model for public health surveillance systems
encapsulates the integration of these concepts. It outlines the inputs and outcomes and emphasizes the
crucial actions and resources for effective system operation, including the imperative of training and
capacity development.
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
AUTOMATIC AND NON-INVASIVE CONTINUOUS GLUCOSE MONITORING IN PAEDIATRIC PATIENTShiij
Glycated haemoglobin does not allow you to highlight the effects that food choices, physical activity and
medications have on your glycaemic control day by day. The best way to monitor and keep track of the
immediate effects that these have on your blood sugar levels is self-monitoring, therefore the use of a
glucometer. Thanks to this tool you have the possibility to promptly receive information that helps you to
intervene in the most appropriate way, bringing or keeping your blood sugar levels as close as possible to
the reference values indicated by your doctor. Currently, blood glucose meters are used to measure and
control blood glucose. Diabetes is a fairly complex disease and it is important for those who suffer from it
to check their blood sugar (blood sugar) periodically throughout the day to prevent dangerous
complications. Many children newly diagnosed with diabetes and their families may face unique challenges
when dealing with the everyday management of diabetes, including treatments, adapting to dietary
changes, and the routine monitoring of blood glucose. Many questions may also arise when selecting a
blood glucose meter for paediatric patients. With current blood glucose meters, even with multiple daily
self-tests, high and low blood glucose levels may not be detected. Key factors that may be considered when
selecting a meter include accuracy of the meter; size of the meter; small sample size required for testing;
ease of use and easy-to-follow testing procedure; ability for alternate testing sites; quick testing time and
availability of results; ease of portability to allow testing at school and during leisure time; easyto- read
numbers on display; memory options; cost of meter and supplies. In this study we will show a new
automatic portable, non-invasive device and painless for the daily continuous monitoring (24 hours a day)
of blood glucose in paediatric patients.
INTEGRATING MACHINE LEARNING IN CLINICAL DECISION SUPPORT SYSTEMShiij
This review article examines the role of machine learning (ML) in enhancing Clinical Decision Support
Systems (CDSSs) within the modern healthcare landscape. Focusing on the integration of various ML
algorithms, such as regression, random forest, and neural networks, the review aims to showcase their
potential in advancing patient care. A rapid review methodology was utilized, involving a survey of recent
articles from PubMed and Google Scholar on ML applications in healthcare. Key findings include the
demonstration of ML's predictive power in patient outcomes, its ability to augment clinician knowledge,
and the effectiveness of ensemble algorithmic approaches. The review highlights specific applications of
diverse ML models, including moment kernel machines in predicting surgical outcomes, k-means clustering
in simplifying disease phenotypes, and extreme gradient boosting in estimating injury risk. Emphasizing
the potential of ML to tackle current healthcare challenges, the article highlights the critical role of ML in
evolving CDSSs for improved clinical decision-making and patient care. This comprehensive review also
addresses the challenges and limitations of integrating ML into healthcare systems, advocating for a
collaborative approach to refine these systems for safety, efficacy, and equity.
BRIEF COMMENTARY: USING A LOGIC MODEL TO INTEGRATE PUBLIC HEALTH INFORMATICS ...hiij
The COVID-19 pandemic has been a watershed moment in public health surveillance, highlighting the
crucial role of data-driven insights in informing health actions and policies. Revisiting key concepts—
public health, epidemiology in public health practice, public health surveillance, and public health
informatics—lays the foundation for understanding how these elements converge to create a robust public
health surveillance system framework. Especially during the COVID-19 pandemic, this integration was
exemplified by the WHO efforts in data dissemination and the subsequent global response. The role of
public health informatics emerged as instrumental in this context, enhancing data collection, management,
analysis, interpretation, and dissemination processes. A logic model for public health surveillance systems
encapsulates the integration of these concepts. It outlines the inputs and outcomes and emphasizes the
crucial actions and resources for effective system operation, including the imperative of training and
capacity development.
INTEGRATING MACHINE LEARNING IN CLINICAL DECISION SUPPORT SYSTEMShiij
This review article examines the role of machine learning (ML) in enhancing Clinical Decision Support
Systems (CDSSs) within the modern healthcare landscape. Focusing on the integration of various ML
algorithms, such as regression, random forest, and neural networks, the review aims to showcase their
potential in advancing patient care. A rapid review methodology was utilized, involving a survey of recent
articles from PubMed and Google Scholar on ML applications in healthcare. Key findings include the
demonstration of ML's predictive power in patient outcomes, its ability to augment clinician knowledge,
and the effectiveness of ensemble algorithmic approaches. The review highlights specific applications of
diverse ML models, including moment kernel machines in predicting surgical outcomes, k-means clustering
in simplifying disease phenotypes, and extreme gradient boosting in estimating injury risk. Emphasizing
the potential of ML to tackle current healthcare challenges, the article highlights the critical role of ML in
evolving CDSSs for improved clinical decision-making and patient care. This comprehensive review also
addresses the challenges and limitations of integrating ML into healthcare systems, advocating for a
collaborative approach to refine these systems for safety, efficacy, and equity.
Health Informatics - An International Journal (HIIJ)hiij
Healthcare Informatics: An International Journal is a quarterly open access peer-reviewed journal that Publishes articles which contribute new results in all areas of the health care.
The journal focuses on all of aspect in theory, practices, and applications of Digital Health Records, Knowledge Engineering in Health, E-Health Information, and Information Management in healthcare, Bio-Medical Expert Systems, ICT in health promotion and related topics. Original contributions are solicited on topics covered under the broad areas such as (but not limited to) listed below:
The Proposed Guidelines for Cloud Computing Migration for South African Rural...hiij
It is now overdue for the hospitals in South African rural areas to implement cloud computing technologies in order to access patient data quickly in an emergency. Sometimes medical practitioners take time to attend patients due to the unavailability of kept records, leading to either a loss of time or the reassembling of processes to recapture lost patient files. However, there are few studies that highlight challenges faced by rural hospitals but they do not recommend strategies on how they can migrate to cloud computing. The purpose of this paper was to review recent papers about the critical factors that influence South African hospitals in adopting cloud computing. The contribution of the study is to lay out the importance of cloud computing in the health sectors and to suggest guidelines that South African rural hospitals can follow in order to successfully relocate into cloud computing.The existing literature revealed that Hospitals may enhance their record-keeping procedures and conduct business more effectively with the help of the cloud computing. In conclusion, if hospitals in South African rural areas is to fully benefit from cloud-based records management systems, challenges relating to data storage, privacy, security, and the digital divide must be overcome.
SUPPORTING LARGE-SCALE NUTRITION ANALYSIS BASED ON DIETARY SURVEY DATAhiij
While online survey systems facilitate the collection on copious records on diet, exercise and other healthrelated data, scientists and other public health experts typically must download data from those systems
into external tools for conducting statistical analyses. A more convenient approach would enable
researchers to perform analyses online, without the need to coordinate additional analysis tools. This
paper presents a system illustrating such an approach, using as a testbed the WAVE project, which is a 5-
year childhood obesity prevention initiative being conducted at Oregon State University by health scientists
utilizing a web application called WavePipe. This web application has enabled health scientists to create
studies, enrol subjects, collect physical activity data, and collect nutritional data through online surveys.
This paper presents a new sub-system that enables health scientists to analyse and visualize nutritional
profiles based on large quantities of 24-hour dietary recall records for sub-groups of study subjects over
any desired period of time. In addition, the sub-system enables scientists to enter new food information
from food composition databases to build a comprehensive food profile. Interview feedback from novice
health science researchers using the new functionality indicated that it provided a usable interface and
generated high receptiveness to using the system in practice.
AN EHEALTH ADOPTION FRAMEWORK FOR DEVELOPING COUNTRIES: A SYSTEMATIC REVIEWhiij
#Health #clinic #education #StaySafe #pharmacy #healthylifestyle
call for papers..!
-----------------------------
Health Informatics: An International Journal (HIIJ)
ISSN : 2319 - 2046 (Online); 2319 - 3190 (Print)
Here's where you can reach us : hiij@aircconline.com
visit us on : https://airccse.org/journal/hiij/index.html
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published articles..!
AN EHEALTH ADOPTION FRAMEWORK FOR
DEVELOPING COUNTRIES: A SYSTEMATIC REVIEW
https://aircconline.com/hiij/V10N3/10321hiij01.pdf
GENDER DISPARITYOF TUBERCULOSISBURDENIN LOW-AND MIDDLE-INCOME COUNTRIES: A SY...hiij
The tuberculosis burden is higher in the population from low- and middle-income countries (LMICs) and
differently affects gender. This review explored risk factors that determine gender disparity in tuberculosis
in LMICs. The research design was a systematic review. Three databases; Google Scholar, PubMed, and
HINARI provided 69 eligible papers.The synthesized data were coded, grouped and written in a descriptive
narrative style. HIV-TB co-infected women had a higher risk of mortality than TB-HIV-infected men. The
risk of Vitamin-D deficiency-induced tuberculosis was higher in women than in men. Lymph node TB,
breast TB, and cutaneous and abdominal TB occurred commonly in women whereas pleuritis, miliary TB,
meningeal TB, pleural TB and bone and joint TB were common in men. Employed men had higher contact
with tuberculosis patients and an increased chance of getting the disease. Migrant women were more likely
to develop tuberculosis than migrant men. The TB programmers and policymakers should balance the
different gaps of gender in TB-related activities and consider more appropriate approaches to be genderbased and have equal access to every TB-associated healthcare.
BRIEF COMMUNICATIONS DATA HYGIENE: IMPORTANT STEP IN DECISIONMAKING WITH IMPL...hiij
Medical and health data that have been entered into an electronic data system in real-time cannot be
assumed to be accurate and of high quality without verification. The adoption of the electronic health
record (EHR) by many countries to the support care and treatment of patients illustrates the importance of
high quality data that can be shared for efficient patient care and the operation of healthcare systems.
This brief communication provides a high-level overview of an EHR system and practices related to high
data quality and data hygiene that could contribute to the analysis and interpretation of EHR data for use
in patient care and healthcare system administration.
NUMERICAL SIMULATIONS OF HEAT AND MASS TRANSFER IN CONDENSING HEAT EXCHANGERS...ssuser7dcef0
Power plants release a large amount of water vapor into the
atmosphere through the stack. The flue gas can be a potential
source for obtaining much needed cooling water for a power
plant. If a power plant could recover and reuse a portion of this
moisture, it could reduce its total cooling water intake
requirement. One of the most practical way to recover water
from flue gas is to use a condensing heat exchanger. The power
plant could also recover latent heat due to condensation as well
as sensible heat due to lowering the flue gas exit temperature.
Additionally, harmful acids released from the stack can be
reduced in a condensing heat exchanger by acid condensation. reduced in a condensing heat exchanger by acid condensation.
Condensation of vapors in flue gas is a complicated
phenomenon since heat and mass transfer of water vapor and
various acids simultaneously occur in the presence of noncondensable
gases such as nitrogen and oxygen. Design of a
condenser depends on the knowledge and understanding of the
heat and mass transfer processes. A computer program for
numerical simulations of water (H2O) and sulfuric acid (H2SO4)
condensation in a flue gas condensing heat exchanger was
developed using MATLAB. Governing equations based on
mass and energy balances for the system were derived to
predict variables such as flue gas exit temperature, cooling
water outlet temperature, mole fraction and condensation rates
of water and sulfuric acid vapors. The equations were solved
using an iterative solution technique with calculations of heat
and mass transfer coefficients and physical properties.
CW RADAR, FMCW RADAR, FMCW ALTIMETER, AND THEIR PARAMETERSveerababupersonal22
It consists of cw radar and fmcw radar ,range measurement,if amplifier and fmcw altimeterThe CW radar operates using continuous wave transmission, while the FMCW radar employs frequency-modulated continuous wave technology. Range measurement is a crucial aspect of radar systems, providing information about the distance to a target. The IF amplifier plays a key role in signal processing, amplifying intermediate frequency signals for further analysis. The FMCW altimeter utilizes frequency-modulated continuous wave technology to accurately measure altitude above a reference point.
Using recycled concrete aggregates (RCA) for pavements is crucial to achieving sustainability. Implementing RCA for new pavement can minimize carbon footprint, conserve natural resources, reduce harmful emissions, and lower life cycle costs. Compared to natural aggregate (NA), RCA pavement has fewer comprehensive studies and sustainability assessments.
Forklift Classes Overview by Intella PartsIntella Parts
Discover the different forklift classes and their specific applications. Learn how to choose the right forklift for your needs to ensure safety, efficiency, and compliance in your operations.
For more technical information, visit our website https://intellaparts.com
Immunizing Image Classifiers Against Localized Adversary Attacksgerogepatton
This paper addresses the vulnerability of deep learning models, particularly convolutional neural networks
(CNN)s, to adversarial attacks and presents a proactive training technique designed to counter them. We
introduce a novel volumization algorithm, which transforms 2D images into 3D volumetric representations.
When combined with 3D convolution and deep curriculum learning optimization (CLO), itsignificantly improves
the immunity of models against localized universal attacks by up to 40%. We evaluate our proposed approach
using contemporary CNN architectures and the modified Canadian Institute for Advanced Research (CIFAR-10
and CIFAR-100) and ImageNet Large Scale Visual Recognition Challenge (ILSVRC12) datasets, showcasing
accuracy improvements over previous techniques. The results indicate that the combination of the volumetric
input and curriculum learning holds significant promise for mitigating adversarial attacks without necessitating
adversary training.
About
Indigenized remote control interface card suitable for MAFI system CCR equipment. Compatible for IDM8000 CCR. Backplane mounted serial and TCP/Ethernet communication module for CCR remote access. IDM 8000 CCR remote control on serial and TCP protocol.
• Remote control: Parallel or serial interface.
• Compatible with MAFI CCR system.
• Compatible with IDM8000 CCR.
• Compatible with Backplane mount serial communication.
• Compatible with commercial and Defence aviation CCR system.
• Remote control system for accessing CCR and allied system over serial or TCP.
• Indigenized local Support/presence in India.
• Easy in configuration using DIP switches.
Technical Specifications
Indigenized remote control interface card suitable for MAFI system CCR equipment. Compatible for IDM8000 CCR. Backplane mounted serial and TCP/Ethernet communication module for CCR remote access. IDM 8000 CCR remote control on serial and TCP protocol.
Key Features
Indigenized remote control interface card suitable for MAFI system CCR equipment. Compatible for IDM8000 CCR. Backplane mounted serial and TCP/Ethernet communication module for CCR remote access. IDM 8000 CCR remote control on serial and TCP protocol.
• Remote control: Parallel or serial interface
• Compatible with MAFI CCR system
• Copatiable with IDM8000 CCR
• Compatible with Backplane mount serial communication.
• Compatible with commercial and Defence aviation CCR system.
• Remote control system for accessing CCR and allied system over serial or TCP.
• Indigenized local Support/presence in India.
Application
• Remote control: Parallel or serial interface.
• Compatible with MAFI CCR system.
• Compatible with IDM8000 CCR.
• Compatible with Backplane mount serial communication.
• Compatible with commercial and Defence aviation CCR system.
• Remote control system for accessing CCR and allied system over serial or TCP.
• Indigenized local Support/presence in India.
• Easy in configuration using DIP switches.
HEAP SORT ILLUSTRATED WITH HEAPIFY, BUILD HEAP FOR DYNAMIC ARRAYS.
Heap sort is a comparison-based sorting technique based on Binary Heap data structure. It is similar to the selection sort where we first find the minimum element and place the minimum element at the beginning. Repeat the same process for the remaining elements.
Saudi Arabia stands as a titan in the global energy landscape, renowned for its abundant oil and gas resources. It's the largest exporter of petroleum and holds some of the world's most significant reserves. Let's delve into the top 10 oil and gas projects shaping Saudi Arabia's energy future in 2024.
Cosmetic shop management system project report.pdfKamal Acharya
Buying new cosmetic products is difficult. It can even be scary for those who have sensitive skin and are prone to skin trouble. The information needed to alleviate this problem is on the back of each product, but it's thought to interpret those ingredient lists unless you have a background in chemistry.
Instead of buying and hoping for the best, we can use data science to help us predict which products may be good fits for us. It includes various function programs to do the above mentioned tasks.
Data file handling has been effectively used in the program.
The automated cosmetic shop management system should deal with the automation of general workflow and administration process of the shop. The main processes of the system focus on customer's request where the system is able to search the most appropriate products and deliver it to the customers. It should help the employees to quickly identify the list of cosmetic product that have reached the minimum quantity and also keep a track of expired date for each cosmetic product. It should help the employees to find the rack number in which the product is placed.It is also Faster and more efficient way.
RAT: Retrieval Augmented Thoughts Elicit Context-Aware Reasoning in Long-Hori...
A novel framework for electronic global
1. Health Informatics-An International Journal (HIIJ) Vol.4, No.1/2, May 2015
DOI: 10.5121/hiij.2015.4201 1
A NOVEL FRAMEWORK FOR ELECTRONIC GLOBAL
HEALTH RECORD ACCESS
Nael A.H AbuOun1
, Ayman Abdel-Hamid1
, and Mohamad Abou El-Nasr2
1
College of Computing and Information Technology
2
College of Engineering and Technology
Arab Academy for Science, Technology, and Maritime Transport, Alexandria, Egypt
ABSTRACT
When most patients visit physicians in a clinic or a hospital, they are asked about their medical history and
related medical tests’ results which might not exist or might simply have been lost over time. In emergency
situations, many patients suffer or sadly die because of lack of pertinent medical information. Patient’s
Health information (PHI) saved by Electronic Medical Record (EMR) could be accessible only by a
hospital using their EMR system. Furthermore, Personal Health Record (PHR) information cannot be
solely relied on since it is controlled solely by patients. This paper introduces a novel framework for
accessing, sharing, and controlling the medical records for patients and their physicians globally, while
patients’ PHI are securely stored and their privacy is taken into consideration. Based on the framework, a
proof of concept prototype is implemented. Preliminary performance evaluation results indicate the validity
and viability of the proposed framework.
KEYWORDS
Global Health Record, Electronic Medical Record, GHR, EMR, HER, PHR
1. INTRODUCTION
Most people have their health information scattered in many different places. Health Information
could be kept at the patient’ household (Papers, or electronic format), at their physician or
therapist office, anywhere they've been hospitalized before, or at any personal website. Hence,
many problems occur when collecting all health information of the patient in a reasonable time.
The best solution to solve such problems is to keep all health information together in one place
along with all the medical actors (physicians, hospitals, patients, Ministries of Health (M.O.H),
World Health Organization (W.H.O)) and specifying privileges for accessing what is needed
when it is needed through the right actor.
Medical Records of a patient consist of medical and personal health information, such as medical
history, care or treatments received, any test results done before, diagnoses from physicians, and
any medications taken. In many places such record is still paper-based and is susceptible for loss
or damage.
The use of the PHI as a digital format went through three successive techniques starting with the
Electronic Medical Record (EMR), then the Electronic Health Record (EHR), and finally the
Personal Health record (PHR). The first technique, Electronic Medical Record, is defined as ―a
digital version of a paper chart that contains all of a patient’s medical history from one practice.
2. Health Informatics-An International Journal (HIIJ) Vol.4, No.1/2, May 2015
2
An EMR is mostly used by providers for diagnosis and treatment‖ [1]. The problem with EMR is
that it is hospital dependent and thus is very much similar to the paper-based technique of saving
medical data.
The second technique, Electronic Health Record, is defined as “a longitudinal electronic record
of patient health information generated by one or more encounters in any care delivery setting.
Included in this information are patient demographics, progress notes, problems, medications,
vital signs, past medical history, immunizations, laboratory data and radiology reports‖ [2].
Estonia was the first country to implement the first nationwide Electronic Health Record (EHR)
in the world [3], which was launched on December 17, 2008 [4].
EHR has many advantages over EMR for the medical care specialist which can be different from
one system to another [5]. According to Centers for Disease (CDC) and Prevention's National
Center for Health Statistics survey of 2011 in USA, 85% of physicians are satisfied with their
EHRs system, and 74% reported that EHRs enhanced their overall patient care [6]. The largest
integrated healthcare EHR in USA is VistA_EHR providing care to over 8 million veterans,
employing 180,000 medical personnel and operating 163 hospitals, and over 800 clinics [7].
VistA_EHR is also implemented in Jordan (Oct. 2009) since it was proven as national-scale
enterprise system capable of scaling to hundreds of hospitals [8]. UK spends over $24 Billion to
have all patients with a centralized electronic health record by 2010, but the program was
dismantled after the high cost [9]. Canada started the EHR system in 2004 under the name
MyHealthAlberta for Alberta province allowing health professionals to view patient provincial
medication profiles and a selection of local laboratory test results [10].
Since both EMR and EHR were run only by hospitals or medical specialists, patients have no
access to their PHI outside hospitals in the majority of EHRs. Consequently, a new technique was
found called Personal Health Record (PHR) defined as ―a set of computer-based tools that allow
people to access and coordinate their lifelong health information and make appropriate parts of
it available to those who need it‖ [11] [12].
PHR is portable and is kept with the patient and contains medical lifelong information. It should
not be restricted by file formats or other local issues. PHR gave the patient the ability to share
their PHI with other medical care centres and the ability to control their record. However,
patients’ PHI was still hard to be accessed in emergency situations. If the patient went in a
comma, he/she won’t be able to inform physicians where his/her PHR is located, and thus it is
useless in such cases. According to a conducted survey [13] in an ongoing research effort, more
than 90% of physicians need more than five minutes to retrieve patient’s record, and 71% of
targeted physician says they did face situations like that and explained how hard it was to deal
with such situations like that [13]. Other examples of PHR are explained in related work.
Consequently, the new idea of a Global Health Record was introduced. It started in 2004 with
The USA Armed Forces Health Longitudinal Technology Application “(AHLTA) is the military's
electronic health record, marks a significant new era in healthcare for the Military Health System
(MHS) and the nation. It is used by medical providers of the U.S. Department of Defense (DOD)
since its initial implementation in January 2004. AHLTA is a services-wide medical and dental
information management system‖ [14].
This paper introduces a framework that merges the benefits of EMR and PHR into one medical
record called Global Health Record (GHR). GHR is a new methodology for making the medical
record globally accessible anytime anywhere, allowing physicians to access patients’ information
from one location quickly granting privacy to the patient’s information with high level of
security. In this framework, patients do have full control over their record and at the same time
3. Health Informatics-An International Journal (HIIJ) Vol.4, No.1/2, May 2015
3
physicians are allowed to access that record and have the ability to modify it. All actors can
access the framework from the same domain which redirects each user according to their
geographical location to the nearest front end (Figure (1)). Users then get authenticated, after that
the medical data is required from the backend server which is located in a different cloud
controlled by the patients’ ministry of health in his/her country. The communication between the
different backbend’s is controlled by the W.H.O. cloud which identifies the backend servers and
publishes their public keys.
Patients, physicians, hospitals, and all medical actors can access the framework from any Internet
browser. One advantage of the proposed framework is that it solves the problem of accessing and
sharing the medical record of the patient in a global perspective having the correct information
written by physicians, and also sharing all lab tests. According to a survey conducted to outline
motivation and requirements of the proposed framework [13], more than 71% of physicians face
problems in sharing patient data and face delay in receiving the data in the required time, also
more than 85% of the physicians say that the data in the received records is not accurate [13].
Another advantage of the proposed framework is that it lets the patients add to their records and
also control their information privacy as in PHR. Moreover, this framework helps physicians
around the world in their researches or conducted studies on variant diseases and their
transformations. This is performed without violating patients’ privacy because only the medical
information is provided to physicians with no ties to the patient personal information. According
to the conducted survey more than 78% of physicians reported that it is hard to locate the case
study in search studies [13].
To establish a successful and trusted global medical framework, a trusted global organization
such as (W.H.O.) must manage it. More than 64% of physicians accepted the W.H.O. to manage a
global medical system [13]. W.H.O. has many connections around the world that will make the
implementation of such framework easier. W.H.O. can administrate the framework around the
world and register all ministries of health around the world in the framework authorizing the
communication between different countries. Figure (1) represents the abstract idea of the
framework. It illustrates that each country has its own ―GHR cloud‖ saving and managing its
actors (Hospitals, Physicians, and Patients) who can access the system through the front end
cloud for each country. Proper redirection to the local front end cloud (country-wise) can be
performed through Domain Name System (DNS) redirection. The main management for the
communication between the countries will be administered by the W.H.O. The proposed
framework is designed to be implemented via cloud computing which decreases high expenses of
hardware, using any type of Software as a Service (SaaS), or Platform as a Service (PaaS). More
framework details will be presented in sections III and IV.
The rest of the paper is organized as follows. Section II discusses relevant related work. Section
III introduces the framework’s analysis, design, and comparison versus related work. Section IV
presents proof of concept prototype and performance evaluation results. Finally, Section V
concludes this paper and discusses future work.
4. Health Informatics-An International Journal (HIIJ) Vol.4, No.1/2, May 2015
4
Figure 1 Abstract view of the framework
2. RELATED WORK
Many researches and projects were designed and implemented offering new ideas regarding EHR
and PHR. However, the majority of such work was not designed for global sharing of the
patients’ health information. Moreover, security and privacy were not the most important aspects
which caused data breaches, e.g., in 2011, 380 major data breaches were reported in United
States, involving 500 or more patients' records listed on the website kept by the United States
Department of Health and Human Services (HHS) Office for Civil Rights [15]. Moreover, 2013
was a busy year in medical data breaches according to HIPAA [16], when the five-hospital
Riverside Health System in southeast Virginia announced that close to 1,000 of its patients were
being notified of a privacy breach that continued for four years.
Many research work discussed health records and cloud computing. Scalable and Secure Sharing
of Personal Health Records in Cloud Computing [17] proposed patient-centric framework of
mechanisms for data access control to PHRs stored in semi-trusted servers over cloud. CAM:
Cloud-Assisted Privacy Preserving Mobile Health Monitoring [18] designed a cloud assisted
privacy preserving mobile health monitoring system to protect the privacy of the involved
medical parties and their data. Sensor-Cloud: A Hybrid Framework for Remote Patient
Monitoring [19] used Sensors to enable a patient monitoring system using cloud computing to
monitor human health and share the information among doctors, care-takers, researchers, and
pharmacies. SPOC: A Secure and Privacy-preserving Opportunistic Computing Framework for
Mobile-Healthcare Emergency [20] introduced an efficient user-centric privacy access control,
which is based on an attribute-based access control and a new privacy-preserving scalar product
computation technique. In addition, it allows a medical user to decide who can participate in the
opportunistic computing to assist in processing his overwhelming PHI data. A mobile Phone
based homecare management system on the cloud [21] combined Hospital Information System
(HIS) and mobile communications to establish a telemedicine homecare management system in
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long-term and sustainable health monitoring through the transmission of Multimedia Messaging
Service (MMS).
A medical record is presented in many ways such as internet-based record, which has limitations
relating to privacy and security concerns, information could be shared with others, may be
hacked, and concerns about the internal design of the system and the way it works. Some
examples of such systems include: MyPHR Internet-based PHR brought by AHIMA Foundation
improves health [22], Microsoft Health Vault system [23], Google health which introduced in
2008 and cancelled in 2012, according to Brian Dolan there was 10 reasons why Google health
was terminated [24] [25].
Some other research work explored the idea of using portable medical record such as mobile app,
USB Flash, or on credit-card wallet CDs. Card that could be carried around on key chains,
bracelets, watches, etc. Mycare card MyC2 [26] [27] in UK was developed with GUI software to
control the insertion and modification of data. Privacy Preserving Portable Health Record
(P^3HR) [28] proposes an architecture for USB flash device which provides data encryption, and
strong multifactor authentication using biometrics, public key infrastructure to verify the
credentials of the applicants. However, the device can be damaged and becomes useless in
emergency situations when a patient’s life depends on the data installed on it.
Portable Device PHR [29] proposes the structure for a portable PHR (pPHR) protected by
password and dividing data to five different data types: Confidential, Normal, Transfer,
Prescription, and Emergency and giving privileges according to user type to each section of data.
However, concerns are in place if a patient deals with unregistered user in an emergency situation
or the device gets lost or damaged. MyPHRMachines is PHR with full control of patient, which
allows patients to build PHRs which are robust across the space and time dimensions, and share
these data with different care institutions [30] [31] but still it is PHR which means patients adding
all the information.
Other research and projects can be found on mobile apps for telemedicine such as Dhatri [32], a
mobile Phone based homecare management system on the cloud [21], MTBC PHR, and SecEra
PHR. Figure (2) shows the traditional personal health record system general design [33].
However, if any patient has accounts on all electronic records, this will not do him any good
during an emergency where he can not provide information to physicians (a patient being in a
comma for example). A physician does not know where to look for a PHR or they are not
identified as trusted users.
In this paper, the proposed framework is going to address problems of accessing the medical
record globally by making all patients and medical users securely communicate through one
abstract system for sharing medical information while maintaining patients’ privacy. Hence, the
proposed framework presents a novel framework for electronic global health record access,
allowing all medical actors to access the medical information from anywhere at any time in a
secure manners (see sections III and IV).
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Figure (2) Traditional personal health record system [33]
3. ELECTRONIC GLOBAL HEALTH RECORD ACCESS FRAMEWORK
This section illustrates the framework’s analysis and design, explaining each part of the proposed
system, highlighting the privacy part for the medical information for patients, and the security for
actor’s access to the framework, and comparing between the proposed framework and other
related work.
3.1 Framework Analysis
The framework’s idea was formulated after searching for many EHRs, and PHRs presented in
medical life today. To the best of our knowledge, moving to a global record was considered a
problem since the privacy of data was hard to be saved and making sure that data was not going
to be misused or exposed. This framework is designed to work at global level, considering the
privacy and security of each record and trying to make it easy for medical users around the world
by making one place as a portal gate for all medical actors. The globally trusted organization
(W.H.O) will register all ministries of health around the world giving them proper authentication
to access the framework, and enable them to create the sub-users in each country such as
hospitals, physicians, and all the medical entities in that country as explained in figure (3).
M.O.H. will be the controller of their sub-users by making sure of their registration, log-in
information, and giving them the authentication to use the framework globally.
3.1.1 Framework Actors
Creating users will be done in hierarchical way. W.H.O creates accounts for each ministry of
health, and then each ministry creates their sub-users, and so on as illustrated in figure (3). The
following paragraphs will describe each type of actors discussing the privileges given to each one
starting with the patients:
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Figure (3) the Hierarchical registration process of framework entities
Patients view
Each citizen in his/her country should have an ID Social Security Number in Palestine, Canada
and USA (SSN) is 9 digit number, in Egypt 14 digit number, KSA and Sri Lanka 10 digit, and
UAE 15 digit [34]. Since the SSN is differentiate between different countries, and could identify
the patients; this framework started new ID for each patient to avoid any duplication or mistakes
in patient ID, each patient will have global ID divided as shown in table (1).
Table (1) Patient ID
Country ID Province ID City ID Sequence ID
EG ALX-02 MAN-004 FFFFFF
The ID consists of 19 characters divided into four sections. The first section is the country ID
which is predefined globally, then the province ID defined within the country and then city ID.
Finally, the sequence ID is an automated sequence number. By using this record ID, the patient
will be able to access their record through any browser connected to the Internet, even from
outside their country, by using the username and password created at the time of the record
creation.
Creating the records for the new born babies will be easy since the record will be created in
hospital after birth, and then it should be verified by M.O.H by assigning a SSN to that record.
Regarding current citizens, each one when he/she visits the hospital for the first time they will be
assigned an ID which also will be verified by ministry of health later, and adding all the old data
that was saved in the patient record by hospital employees. For making the record easy usable for
patients there is the ―Session Token – OTP (One Time Password)‖ which can be identified as a
password for other actors access to patient record. No one knows it or can have it except the
patient and it can be created only by the patient when he/she logs in to their account. The session
Token is used when a patient visits a physician at a clinic to give them authority of seeing the full
record with history and any other needed information.
Physicians view
The physicians are going to modify patients’ records and identify their medical situations to be
accessible for any actor requiring this information. Since many countries rely on M.O.H. to
identify the physicians working licenses (according to [13] more than 85% confirmed that M.O.H
issues the licenses to physicians), this framework adopts a similar approach. M.O.H. will be able
to create the physicians account giving them their ID as shown in Table (2). A physician ID
W.H.O.
Employees
M.O.H.
Employees
Hospitals
Departments
Doctor syndicate
Employees
Patients
Medical
records
Physician
Private clinic
Employees
Employees
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consists of 19 characters. The area section is used for patient searches at any emergency situation
to get closest physician to his/her location to ask for special visit. Hence, storing an area ID will
enhance patient’s search results.
Table (2) physician ID
Country ID Province ID City ID Area ID Sequence ID
EG ALX-002 003 003 FFFFF
Hospitals view
Each hospital can have their account by registering through the M.O.H, and each hospital can
have their unique ID, as shown in Table (3).
When a patient visits a hospital to get medical treatment, the case added in his/her record will be
tagged with physician, and hospital IDs. This can help when sometimes a physician could ask for
more medical information about a specific patient from another physician by just looking to who
diagnosed that case for the patient.
For each organization, we suggest to use a second way for authentication with the username and
password to make it more secure in using the framework such as static IP with Virtual Private
Network (VPN) connection, or hardware authentication. The second authentication for that
organization will be identified by M.O.H when creating that organization’s profile to make sure
the usage of the username is located in the right organization, in order to organize the access to
patients’ data to save patient privacy.
Table (3) Hospital ID
Org. identify Code Country ID Province ID City ID Sequence ID
HOS EG Alx-002 002 00001-01
The Records
The record is divided to a number of sections. Each section will have its own storage location in
the cloud to allow for fault-tolerance. The main sections of a record will be medical information
(cases, visits, and notes), insurance information, contact information, and any other information
related to patient’s record.
Each section contains specific data about a patient, for example the contact information section
holds full information about a certain name and how to contact or reach the patient. Such
information is secure and there is no way to link it to other record’s parts except through patient’s
authentication. Other parts may be individually accessed by some other actors according to actor
type and the privileges they had which is also controlled by patients.
Within the cloud, no linkability is available between records’ sections. The only authorized actor
to see the full information from all sections is the patient. Other actors do have the ability to
communicate with the predefined section to that type of actor, for example a physician has the
authority to only view the medical information according to where he/she is located. The patient
has the privilege to give specific actors the access to different record sections.
By dividing the record, the patient will get the highest level of privacy, since the medical
information is saved using a virtual ID that is not linkable to other parts of the record such as a
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patient’s name. This implies that no one can access the patient’s information, except who is
having the privileges to access it. Such privileges can be changed by the patient through their
account settings.
The framework will accept actor login from anywhere and will be able to differentiate between
login locations by using a second authentication method for all registered organizations. Figure
(4) illustrates the communication between physicians and cloud servers while trying to log in
from a hospital network. Each type of actor will get privileges according to the location they are
logging on from.
For protecting a patient’s privacy, the framework limits other actors from accessing the record
from anywhere, allowing a physician to make changes only when a patient is available in front of
them in hospital or clinic by using biometric data (according to the survey in [13], more than 92%
agreed to use the biometric data to identify the patients) or the Session Token of that patient. If a
patient is not physically located with physician then it will allow access as shown in figure (5),
for example when a patient visits a physician in a clinic. The key to view the record will be
patient’s fingerprint, or the Session Token. The record could be accessible for a specific physician
when a patient adds that physician into a trusted list which could contain physicians, and hospitals
trusted by that patient.
Figure (4) physician log in from hospital
scenario
Figure (5) physician log in from clinic scenario
Each type of actor will be granted privileges according to the location they are logging on from.
Physicians can access the framework from different locations such as hospital, clinic, home,
mobile, etc… Each location of access gives the physicians different views of records as outlined
in Table (4).
In some medical research studies, physicians would like to target specific diseases and send new
medication or treatments about that case to the patients. In such case, a physician will not need
the full information about that patient till the patient grants the privileges to that physician. They
can just view diseases’ situation and related medication and which physician did treat it. In order
to get more information about that case from the patient, the physician can communicate with
patient or physician who handles that case without knowing any other information about the
patient till they are granted privileges by the patient. Patient data will be protected from non-
authorized actor access and patient privacy will be maintained.
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3.1.2 Security and Privacy
Many researches can be cited regarding the security and privacy of PHR [35], [36], [37], [38],
[39], [40], and [41]. However, there are still several uncertain issues such as how to manage PHR
information in emergency situations.
When talking about PHI or health records, security and privacy should be considered, the data
privacy according to HIPAA deals with controlling who is authorized to access information.
Hence, in order to maintain PHI privacy, security measures need to be implemented [42].
Medical Privacy can be identified as ―the practice of keeping information about a patient
confidential. This involves both conversational discretion on the part of health care providers,
and the security of medical records.‖ [43]. Furthermore, according to HIPAA privacy of medical
information ―could be the rule focuses on limiting the use and disclosure of sensitive (PHI)‖ [44].
HIPAA (Section 165.501) provides for the protection of individually identifiable health
information that is transmitted or maintained in any form or medium.
Technically, privacy can be classified as: anonymity, unlinkability, undetectability,
unobservability, pseudonymity, or identity management [45], this framework focuses on
anonymity and unlinkability of the patient’s record.
Anonymity of a subject means that the subject is not identifiable within a set of subjects, the
anonymity set. Unlinkability of two or more items of interest (IOI) (e.g., subjects, messages,
actions ...) from attacker’s perspective means that within the system (comprising these and
possibly other items), attacker cannot sufficiently distinguish whether these IOIs are related or not
[45].
Table (4) physician’s privileges according to location
Physician Hospital-Clinic Patient Privileges
Present hospital
Not
present
Searching by names for registered patient by
that hospital only, and get full record. For
patients not registered, just medical
information and searching with IDs, or
diseases
Present hospital Present
By using biometric data, or Session Token
get full record.
Present clinic
Not
present
No ability to search by names except for
patients who previously got treatment from
same physician or patient records them as
trusted physician. Ability to search by cases
or diseases and just medical info can be
viewed.
Present clinic Present Biometric data, or session Token gives full
record to physicianPresent Anywhere Present
Present Anywhere
Not
present
Searching only for treated patients by that
physician, and others only by cases or
diseases and only IDs available no names
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Healthcare cloud applications share common security measures known as the CIA triad
(confidentiality, integrity, and availability of data), and ownership of information, authentication,
non-repudiation, patient consent and authorization. The aforementioned measures are outlined
and handled in the proposed framework as follows.
a) Confidentiality: is defined in ISO-17799 as "ensuring that information is accessible only
to those authorized to have access". Confidentiality can be achieved by access control and
encryption techniques. The GHR record in this framework is saved in the cloud
infrastructure using a digital ID that is just known to the internal service of cloud that is
collecting the data from different locations to send it to an authenticated actor.
Authenticated actors are predefined and each actor type will have specific privileges that
are predefined as well, and controlled by the internal service. The data located in the cloud
is encrypted. Communication between the entities will be also encrypted through
asymmetric cryptography.
b) Integrity: Integrity means preserving the accuracy and consistency of data, and protecting
information from being modified by unauthorized parties or modified in transit. According
to HIPAA, the covered entity is required to provide corroboration of the integrity of the
data through mechanisms such as checksums, CRCs (Cyclic Redundancy Checks), double
keying, message authentication codes or digital signatures [46].
c) Availability: what is the benefit of confidentiality and integrity if the authorized users of
information cannot access and use that data? The framework depends on cloud computing
which means 24/7 availability and fault-tolerance allowing for zero data loss depending on
cloud provisioning of virtual resources.
d) Ownership of information: Any created data is tagged with the creator username. Patient
data is owned and managed by the patient himself.
e) Authentication: each user acquires a username and password for system access. A
tracking service is available for each user to specify the locations they are able to access
the system from. New locations should be confirmed by the user.
f) Non-repudiation: using the audit measure, the framework can record user activities and
save it in the user’s log. It also implies that one party of a transaction cannot deny having
received a transaction nor can the other party deny having initiated a transaction.
g) Patient consent and authorization: each patient knows which physician(s) they do trust.
From the system management board, they can control denying and/or allow sharing their
information with others. In addition, they can monitor who are able to access their record
and what record parts are accessible by that user.
3.2 Comparison versus Related Work
Related research work differs from the proposed framework in many aspects, which is explained
as follows. In summary, Table (5) depicts the comparison between the proposed framework and
related work.
a) Websites EHR, PHR: Susceptible for being hacked and unauthorized use. Data saved
online susceptible for being used without user knowledge. Availability of data is
controlled by the hosting organization which is not trusted. In some cases, when data is
required in any emergency it maybe inaccessible. In addition, there is the problem of
sharing data with other systems or care delivery organization when required.
b) Portable PHR: Could have good availability of data but problem to deal with in some
cases when data is encrypted, and unable to decrypt it. Data saved in the portable device
may have some inaccurate information since it is created by the patient. Susceptible for
being damaged or lost. In addition, there is the problem of sharing data with other
systems or care delivery organization when required.
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c) Smart Card PHR and Mobile Apps: Smart card PHR is susceptible for being damaged or
lost. In addition, in some hospitals data maybe unreadable because of unavailability of
appropriate reader. Moreover, data can be inaccurate since controlled by patient.
Furthermore, there is the problem of sharing data with other systems or care delivery
organization when required.
d) Proposed framework: Could be susceptible for security attacks but data is encrypted and
divided to many distributed parts for increased privacy. The reliance on cloud
infrastructure means high ability and fault-tolerance to recover any lost data. In addition,
data is shareable between all entities an allowing global access to patients’ data.
Table (5) Comparison versus related work
3.3 Framework Design
Adopting a cloud-based framework achieves high availability and fault-tolerance. Such issue is of
paramount importance when designing a GHR access system because seconds could mean all the
difference to patients.
This framework is designed to work with global health records. The actors will be divided
according to the country they belong to, and each country will deploy its own private cloud for
this framework which is able to communicate with other clouds under the management and
control of main Cloud controlled by the W.H.O. This framework design grants each government
(M.O.H.) their national (local) level of control and management. Any country not ready yet to roll
out its own cloud can opt to save its pertinent data under the control of W.H.O till their cloud is
up and running. Other related work discussed the national level of control [48], [49], [50], [51],
and [52].
Our vision for framework infrastructure is designed adopting a multi-cloud setup per country. The
first cloud of servers is considered to be Front end cloud for public access from all entities that
connect to the framework requesting the information. Requests to the front end are relayed to
another cloud of servers (back end cloud), as a secure encrypted request which is not accepting
any communication except from the predefined Front end cloud. After the request is decrypted,
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the required data will be collected from the database, encrypted and sent to the Front end cloud.
The front end cloud formulates the reply and resends it to the user device as shown in Figure (6).
Since actors are differentiated according to their type, each type can access with different
privileges and different connections, such as the predefined organization will be able to access the
system through the VPN connection which will create the secure tunnel for the transferred data as
shown in Figure (6).
Hospitals will be registered in the framework through M.O.H, which will create a new hospital
account, and the required data for that entity such as (IPs, username, location, contact
information, VPN connection Data…). When a hospital account is created, it will be able to setup
a VPN connection to the framework from hospital network and manage all requests to the online
domain to go through the VPN tunnel. The reason for dividing the servers to more than one cloud
is to achieve more security and reduce the overhead to different framework servers. The server
functions will be as described in the following subsections.
Figure (6) General view of the framework servers (clouds) per country
3.3.1 Front end Cloud
The main responsibility for the Front end cloud is to receive all requests from actors and generate
the request to be sent to the backend cloud. The main components of the front end cloud should
include a firewall, a VPN server, and related databases such as the physicians and hospitals
records. In addition, it includes a response web page design generator to formulate data received
from the backend cloud in a format suitable to the end user device.
The front end cloud assigns the privileges to each actor according to their type and the location
they are logging in from. In addition, it performs the decryption and encryption of the transmitted
data to the backend cloud. Each response from the backend cloud will be received as unformatted
data which will be put in a suitable design before it can be sent to the end user device.
3.3.2 Backend Cloud (Database server)
The backend cloud handles patients’ secure data storage. The patient data is divided into unlinked
sections unless access is granted by the patient (see section 3.1.1). Only search by patient ID is
allowed for physicians. This means unlinkability between records and patients unless the linkage
Front End Cloud
Authentication
Server
Back End Cloud
Data center
Communication and
design Server
Home User
Communication Server
Firewall
M.O.H.
Hospital Users
VPN Server
VPN Connection
VPN Connection
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is granted by the patient to physicians. The backend cloud responds to requests relayed by the
front end cloud performing decryption and encryption as deemed necessary.
3.3.3 Actors Connections and Access
More than one scenario exists for actors’ access to the framework for example a physician
performs access from a hospital, or a physician access from anywhere (other than hospital), or
organization access, or patients’ access, or access to foreign patient record. In the following, each
scenario will be described illustrating communication sequence.
Organization access: The organization needs to be registered and owns access information to
establish a VPN connection. First, a log in from the registered IP for that organization is
performed and then a VPN connection to the Front end cloud is attempted which will check the IP
first then authentication data for validity. Upon successful authenticated connection, a VPN
tunnel is created to start accessing the system data. At the organization network, any request will
be routed to the VPN tunnel and the front end cloud will perform authentication.
Physician access from connected hospital: The hospital is already connected to the front end
cloud through a VPN connection. A physician request for access will be authenticated for access
by front end cloud over the secure tunnel. The front end cloud will create a token for that session
including the hospital ID and physician ID. That token will be active for period of time and when
it expires the physician will be requested to re-enter his authentication information. Since the
token is created, the server will collect the data of that physician profile and send it to physician
browser.
Physician access from anywhere other than connected hospital: The physician request for
access will be from a dynamic IP address (un-validated IP address) and not through a VPN
connection. Hence, an HTTPS connection is enforced to the front end cloud requiring proper
authentication. Upon successful connection, the physician profile will be sent to the physician
browser.
Patient access: The patient’s request is directed to the front end cloud. This request is encrypted
and relayed to the back end cloud. The response is formulated, decrypted, and then sent back to
the front end cloud. Upon successful decryption of the response, the reply is sent back to patient
profile with proper page design. When a patient visits a physician in his private clinic for
diagnosis, the logged in physician will search for patient by ID then session Token, or name and
session Token, or fingerprint. The Front end server will create a token for that open session to
inform the backend server with the physician ID who is requesting that information, and also
inform the patient with notification message that the profile was accessed by that physician with
the time of access and physician location information.
Physician access to foreign patient record: The previous scenarios outlined the connections for
local patient record access. When a logged in physician requests a foreign patient record, the front
end will not recognize the ID of that patient so the requested ID will be forwarded to W.H.O.
cloud which will identify the relevant cloud for that patient and redirect the request to it while
notifying the requesting cloud about the location of that record. If that record is marked to be
accessed globally then the requested data will be directly sent to that physician.
4. PROTOTYPE AND PERFORMANCE EVALUATION
A proof of concept prototype was implemented using PHP, with Apache server to clarify the
main idea of the framework, for giving global access to actors, and tested with multiple
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physicians from different countries, getting their acceptance for the main functions. The
framework provided a new way to save the patients’ records, shared the PHI between patients and
other health organizations, and maintained the privacy of the patient. The prototype is accessible
online at http://www.Ghader.net (GHADER stands for Global Health Access for Electronic
Record). For testing purposes, a local version of the prototype is deployed on a local test machine
with specs Intel Core(TM)2 Duo CPU processor running at 1.83GHz, 2.00 GB RAM running
Window 7 Ultimate 32-bit Operating system. Using local server (version: Apache/2.2.4 (Win32)
PHP version: 5.2.3). All framework components were run locally on the test machine.
Jmeter tool [53] was used to record an actor’s actions and then reload it with a number of virtual
users. The actions were recorded with total 90 samples for each Jmeter user. the recorded actions
were as follows: log in as hospital user, create new case for two patients describing each one’s
satuts then log out; and then log in again as physician 1 checking the IP address and edit one case
in his department in that hospital, re-login again from another IP and create new visit for a patient
in physician clinic; then log out and re-login with physician 2 who did same thing as physician 1
for another patient; then patient 1 log to system to check the cases and visits in his record and
create new note explaining his status today. Finally, the second patient does the same thing as
patient 1 for his/her record.
Jmeter was run with multi-users in different ramp-up seconds. The aggregate graph for testing
with about 70000 samples equivalent to almost 800 users in 20 second ramp-up is shown in figure
(7). The average time for requests was about 1.7 seconds. All responses for all requests were
tested and all were correct and affected in the database, with 20 seconds being the maximum time
spent for requests for all users.
Figure (7) aggregate graph for 72780 samples run in 20 second ramp-up
Figure (8) represents the response time for different number of users accessing the implemented
prototype in different ramp-up seconds on a local host. The response is different according to the
number of samples. Each time the number of samples increased, the response time also increased.
At the end of each test, the response time gets stable because all functions and pages were already
loaded which means less load on the server.
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The prototype performance evaluation results show the validity and viability of the framework.
Some functions did require more time than others to get the response but in total the framework
response is acceptable. In the future, a cloud-based prototype will be deployed with real users
from more different countries.
Figure (8) Multi users’ response time
All previous tests were done on a local host. In some tests, the web site http://blazemeter.com/
was used for testing the online domain https://www.ghader.net and the results are as shown in
Figure (9).
Response time for 10 users
Response time for 50 users
Response time for 500 users
Response time for 700 users
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According to the previous tests, it is clear that the response time increases each time more users
access the framework server. The previous tests included access by different type of actors each
time one virtual user from JMeter is created. This created more overload on the server because
some requested pages were not allowed to be open for some actors which created some errors in
the response such as one patient logged in and the queue request was to view another patient’s
records which is allowed to be viewed only by authorized physicians, while that patient is not
authorized to access this page.
Figure (10) shows the change in framework response time according to the number of samples.
The response time increases when the number of samples is increased but it reaches a certain
level when all services are loaded on the server and its starts decreasing due to the web pages
being cached by a user’s browser.
Figure (9) Blazemeter.com results
with 27 users
Figure (10) relation between number of samples and
response time
Implementing such a framework will always face some challenges specially policy limitations.
The W.H.O is recommended to be the manager for adopting the proposed framework, hence
many obstacles will vanish. The only thing we envision to be remaining is the acceptance of the
individual governments to implement the framework in their country and follow the framework
policy and infrastructure. Another point to mention is the cost of implementation which will be
high, but since each country will have their cloud infrastructure and each hospital will integrate
the fingerprint or the biometric reader devices in their system, the cost will be divided between
countries. Hence, we think the cost per country will be reasonable according to the benefits they
will gain.
5. CONCLUSION AND FUTURE WORK
In this paper, we presented a novel framework for accessing the PHI of patients in a global
perspective under the management of W.H.O, combining the advantages of EHR and PHR
together into one record named Global Health Record ―GHR‖. GHR grants both physicians and
patients access to the patient’s medical record but is mainly controlled by the patient. The
proposed GHR can be easily shared and accessed by any medical entities once they are identified
within the framework. Moreover, the privacy of the patient’s information is granted with no
misuse since the medical data is unlinkable to the patient’s personal information, if not allowed
by the patient himself.
According to a conducted survey [13] including 1145 physicians from 18 countries, 92% of
physicians agreed to use the patient’s biometric data to identify the patient and locate his/her
medical record. This is because they think that it is hard to find any data about patients in some
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situations such as elderly patients and patients in comma [13]. Consequently, in future work we
plan to implement the biometric information feature and use a realistic cloud computing setup
with realistic users from many countries under the management of W.H.O.
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AUTHORS
Nael A.H AbuOun received his Bachelor degree in Information Technology at Sindh
University, Pakistan 2004. Currently, he is working towards his master degree of
information systems in the College of Computing and Information Technology, AASTMT,
Alexandria, Egypt. His main research interests are Global Health Record access over
cloud computing.
Ayman Abdel-Hamid is a Professor of Computer Science in the College of Computing
and Information Technology, Arab Academy for Science, Technology, and Maritime
Transport (AASTMT), Alexandria, Egypt. In addition, he currently holds the position of
Head of Computer Science and Software Engineering Departments. He received his Ph.D.
degree in Computer Science from Old Dominion University, VA, USA in May 2003. His
research interests include mobile computing, network-layer mobility support, computer
and network security, distributed systems, and compu ter networks. He is a member of
IEEE, IEEE Computer Society, ACM, and ACM SIGCOMM.
Mohamad Abou El-Nasr is a Professor of Computer Engineering, and Dean of
Educational Affairs, Arab Academy for Science, Technology and Maritime Transport
(AASTMT)—Alexandria, Egypt. He is also affiliated with Virginia Polytechnic Institute
and State University where he works as an adjunct professor in the Bradley Department of
Electrical and Computer Engineering - VTMENA program. He earned both his Ph.D. and
M.Sc. in Electrical and Computer Engineering in March 2003 and December 1999
respectively, from Georgia Institute of Technology, Atlanta GA, USA. His research
interests include UWB systems, physical MAC layer issues in wireless networks, wireless
sensor networks, cloud computing, e-health, and m-health. He is a Senior Member of IEEE
Communications and Computer societies, and a member of ACM.