Report On Ehr System
Report On Ehr System
Report On Ehr System
Introduction
An Electronic Health Record (EHR) is an evolving concept defined as a systematic
collection of electronic health information about individual patients or populations. It is a
record in digital format that is theoretically capable of being shared across different
health care settings and it include a range of data like demographics, medical history,
medication and allergies, immunization status, laboratory test results, radiology images,
vital signs, personal statistics like age and weight, and more. In many cases this sharing
can occur by way of network-connected enterprise-wide information systems and other
information networks or exchanges. The healthcare community generally agrees that
improved use of accurate, current, and clearly understood health information is essential
to the delivery of high-quality, cost-effective healthcare. The benefits of this include
improved clinical documentation and customer service, more efficient clinical
workflows, improved medication management, and reduced transcription and labor costs
.The healthcare industry has traditionally underutilized technology as a means of
improving the delivery of patient care. Even today, organizations still rely on paper
medical records and handwritten notes to inform and make decisions. Digital information
is collated and kept between departments and applications, making access to a patient's
longitudinal record difficult, if not impossible .
Chapter 2.
Literature Review
The traditional way of obtaining and gathering patient information is paperbased Csiszar
(2011)submitted that medical institutions would still rather use paper to gather
information from their patients and also to record surgical procedures, observations and
prescriptions. Some practitioners and physicians find accessing digital records somewhat
complicated than obtaining a notepad and a pen. The thing that makes manual keeping of
records very exhausting may be the mere undeniable fact that every day, a large number
of new records are being stored in hospitals. It will be very complicated to sort medical
records of all patients that keep increasing every minute. This complexity often arises to
errors that will greatly get new daily happenings in hospitals, clinics and all sorts of other
healthcare institutions. Aside from being time-consuming, collating records can be hard if
you have no main paperback that may contain all information. The primary reasons for
going to a paperless environment might be any or all of the following: proved medical
documentation, increasing staff and/or instrumentation efficiency, reduction in
overhead and the growth in practice, maximum coding revenues, eliminating record
keeping space, enhancing the standard of care, accumulating information for managed
care contracting, improving inter and intra office communications, standardizing an
information platform for a physician group. 24 Journal of Computer Science and
Information Technology, Vol. 2(2), June 2014 The electronic health record (EHR) is
increasingly being deployed within healthcare organizations to improve the safety and
quality of care. However PoissantEt al. (2005) enumerated some factorsthat are
influencing the achievement of these goals while Zhang & Patel (2006) list the major
benefits EHR systems would offer if well implemented.
legacy medical devices, and delivers this information to the medical centers cloud for
storage, processing, and distribution. With this, medical specialists can monitor patients
at any place through the web (on a computer or mobile phones) and the
system utilizes micro controllers to analyze collected data. However, there was no
provision for confidentiality, integrity and privacy of patient data in this design. Also, the
system has a complex architecture which may be difficult to implement in developing
societies due to lack of infrastructural facilities. Saif, Wani, & Khan (2010) proposed a
network engineering solution for data sharing across healthcare providers for protecting
patients health data privacy in an
Padhy, Patra, &Satapathy (2012)designed and presented the implementation of a cloud
based rural healthcare information system model. The system employs a cloud central
server that accepts virtual machines as tenants. The tenants are secure individual state-ofthe-art facilities that store information in different healthcare centres. The connectivity
and configuration of the cloud rural healthcare information is based on the service
provider policy and location of the cloud data centre. 26 Journal of Computer Science
and Information Technology, Vol. 2(2), June 2014 Internet is the main communication
link between the service provider and rural healthcare centre. It also maintains the
network traffic between the physical resources and the cloud. The authentication server
uses the authentication and authorization mechanisms. With this model, patients can view
their health records and prescriptions on their mobile phones on a request basis. The
system can be used to share information seamlessly and in near real-time across devices
and other applications.
Chapter 3.
DESCREIBE CLOUD IN EHR SYSTEM\
3.1 Cloud-Based EHR vs. Client-Server
EHR systems basically fall into two categories: cloud-based or client-server. In a cloudbased system, a practices data is stored on external servers and can be accessed via the
web, requiring only a computer with an Internet connection.
Client-server systems store data in house, requiring a server, hardware and software be
installed in the physicians office. While in-house servers have traditionally been the
norm, practices are increasingly switching to the cloud for a number of reasons.
contains large pools of systems that are linked together. Often, virtualization techniques
are used to maximize the power of cloud computing.
3.3 Benefits of Cloud-Based EHR
2. Scalable Infrastructure: Any business is bound to grow and will require more
physical and computing resources to match the growth. A well managed business
makes sure that the infrastructure remains scalable and dynamic. As platform-as-aservice is gaining more maturity, in future there are opportunities for organizations to
enhance their infrastructure as per their needs. It will be easier for business to shift
technology base because they are paying only for what they are using. Data can be
stored and managed well in servers than on private servers. It will no longer require
IT personnel to worry about keeping software up to date. This will be handled by
vendors
themselves.
ii.
iii.
The providers across health care organizations to provide better care and
counsel them.
4. Accessing Insurance Details over cloud: Many Insurance companies offer assorted
health insurance products and related services including medical, pharmacy, disability
plans etc. to endow with better service to their customers. Imagine payers having
millions of customers who want their insurance policy to help them effortlessly deal
with payment process in any health care organization who in turn contacts either
patients insurer, pharmacy benefit manager or other health care payer to determine
whether it will pay for patients medication and the amount of their co-payment.
Dealing with this ongoing process is time consuming, might lead to inaccurate claims
assessments, delayed settlementsetc. since they access and verify patients
demographic details with their records and acquiring their health information i.e.
medical bills, prescription informationetc to reimburse according to the insurance
plan that their user has enrolled for. However providing access to insurance details of
a patient over cloud can ease the claim process.Using community cloud as the
deployment model, patients medical information will comply with medical data
privacy and its security as per HIPAA law. This will immensely help in providing a
better customer service. This will not only reduce time of payers as well as the
providers but will also be cost effective and will attain customer satisfaction which is
significant in any business to run successfully.
5. Easy and Fast Access: Primary Care Physicians, pharmacists, clinical and
administrative staffs need more information and that too in a faster way to improve
quality of healthcare and control costs. Imagine a physician who has a patient to see
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but is not available in the clinic for some reason. What if the physician can access
patients details and provide counseling using his mobile or palmtop?Lack of IT
budget: Lack of financial budget is what most Healthcare IT departments face. Since
IT does not directly contribute towards profit of an organization, it is sometimes
neglected and is expected to deliver more with less. In the HIMSS survey, nearly onequarter (24 percent) said lack of adequate financial resources/lack of budget would be
the most significant barrier to successful healthcare IT implementation at their
organization. Providing a cost-effective alternative solution to cloud is a much bigger
challenge for decision makers in these organizations.
as number of stores opened in new locations, the employee count per year, total
prescriptions filled and the number of customers served daily. These details can be
used to continually improve the quality and effectiveness of the health care and
services that is been provided. Health reports to business associates can be disclosed
only under HIPAA rules and regulations to maintain protection of health information.
Using a public cloud as one of the deployment models whereby resources such as
applications and storage are dynamically available as well as the information to the
general public over the internet compounds the security concerns and is not a feasible
option with the imposed restrictions but collaboration with companies with like
interests/ needs and payers (Insurance companies) has paved the way for building a
community cloud. Community cloud as the name suggests is one of the other
deployment models that can share infrastructure between several health organizations
and payers (Insurance companies) from a specific community with common concerns
(like mission, security requirements, policy, and compliance considerations). As data
privacy and security policy revolves around patients medical data, it is always vital
to be concerned about patients crucial medical information when stepping into new
technology era. To deal with the concerns, community cloud promises to protect the
data and share it among the health organizations depending upon patients consent
and since all parties are governed by HIPPA, it is likely to produce a more secure
environment.
A community cloud may not offer the same advantages as that by a public cloud but
it does allow organizations to facilitate and alter their needs on an ongoing basis with
appropriate security controls. Using the community cloud means that a bunch of third
party services on public cloud will not be available. Even if these services are present
in community, there will not be many options to choose from. Imposing security
policies at various levels is always cumbersome. Governing and managing the
infrastructure which has always been a challenge and requires considerable human
effort in a healthcare company can be addressed in a community cloud which is
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governed by a team of few experts. The regulatory demands for healthcare data are
among the most stringent in industry. Thus with community cloud patients medical
and other respective data can be well monitored, shared across the healthcare
companies in community and can be easily accessible by the payers (Insurance
companies). As most organizations store each patient's medical records and other data
in a digital manner, it will allow the healthcare providers (pharmacists, nurse
practitionersetc) across the community to diagnose, perform counseling and track
patients faster and more effectively irrespective of location, especially when multiple
specialists are needed. It results in lower costs and better care for the patients who
require scheduled or immediate service.
Since healthcare providers can access their virtualized desktops from anywhere using
devices such as mobile, laptop etc, it is possible to serve customers even when the
provider is not present in a store or clinic.Patients suffering from chronic diseases can
receive counseling by medical experts if the patients data is available over cloud.
Benefits offered by cloud-computing will help Healthcare players to improve their
business processes and hence the way they offer services to customer keeping in
mind that offering better customer service always remains the main agenda.
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Most physicians who are skeptical of cloud-based EHR systems cite security as a primary
concern. While uncertainty is understandable, web-based EHR systems can actually
deliver greater security than client-server systems and paper records.
Web-based EHR systems achieve HIPAA compliance through data centers with banklevel security and high-level encryption methods that render data unreadable even if a
security breach occurs. Client-server systems are often left unencrypted and only as
secure as the room where they are stored.
Cloud-based data is safer than paper and client-server records in the event of a natural
disaster or fire because the data is backed up securely in multiple locations. Backups for
client-server records are most vulnerable to breach in transport to storage facilities, unlike
cloud systems.
Most people are already allowing a great deal of their sensitive data to be stored in the
cloud. Email systems like Gmail and Yahoo! are stored in the cloud. Online banking,
shopping and personal information on social sites like Facebook are all cloud-based
systems as well.
Ultimately, cloud-based EHR systems provide users of all sizes and industries great
advantages in cost savings, data accessibility and security. Now, medical practices just
have to be willing to look to the cloud for the future of healthcare IT.
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Chapter 4.
Design Methodology
This section introduces the proposed design of the cloud based electronic
medical record system.
ii.
4.2.1Cloud-Based System
The cloud-based system consists of a central database server, Unifier Interface
Middleware (UIM) and anAuthentication Server.
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4.2.1.2 Middleware
This part of the cloud provides a common platform for all the EHR systems of the
sharing hospitals. It has an interface that masks the heterogeneity of all
collaborating hospitals EHR standards, to facilitate the communication
transactions between the Central Database and hospitals systems. It recognizes
any type of EHR standard it communicates with. This middleware remains in the
cloud and communicates with the sharing hospitals via network connections. In
this regard, each hospital does not need to have its own separate mask interface in
order to benefit from the cloud; just an interface is enough to handle the job.
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Chapter 5.
After a successful login by a doctor, the home screen granting access to continue is
displayed as shown in Figure 5.When you click to continue, a dialog box appears where
you can search for the record of a patient directly from the database of the hospital by
typing the first name in the search bar and clicking on search.
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However, if there is an attempt by an unauthorized user to gain access into the system by
inputting incorrect details (i.e. incorrect username and password), the system denies such
a user the access as shown in Figure 4.
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However, if the patient does not have a record with the hospital, the application displays
a No Result Found message as shown in Figure 7.
When searching for a patients record in the cloud database and a No Record Found
message is displayed, it means that the patient does not have a record with Hospital A.
The doctor can connect to the Cloud Server in order to look up the patients record in
Hospital B. To do this, the doctor clicks on File and then clicks on Connect to Cloud. A
Connect to Cloud dialogue box pops up and the doctor enters the connection details for
the destination hospital as shown in Figure 8.
The system performance was found to be satisfactory when tested using different attack
scenarios by the twenty users on the PCs.Records of new patients visiting the hospital
for the first time can be created.For example, the contact information of a new patient can
be added by clicking on the Add Patient option in the Patient menu. Then the Add
Contact Information option is clicked.
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To add new information, click on New and then Save to add the new record you created
to the database of the hospital. The medical information of a new patient can be added by
clicking on Patients, Add Patient, Add Medical Information and New. Then, you click on
Save to add the record to the database of the hospital.
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Conclusions
In this work, a cloud-based enterprise electronic health records system has been designed
and
implemented. Cloud computing (CC) has been widely recognized as the next
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