Securing Electronic Medical Record and Electronic Health Record Systems Through an Improved Access Control

2015 ◽  
pp. 17-30 ◽  
Author(s):  
Pasupathy Vimalachandran ◽  
Hua Wang ◽  
Yanchun Zhang
Keyword(s):  
Access Control ◽  
Electronic Health Record ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Health Record ◽  
Electronic Health

scholarly journals Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure.

2014 ◽  
Vol 05 (03) ◽  
pp. 670-684 ◽  
Author(s):  
P. Marken ◽  
Y. Zhong ◽  
S. D. Simon ◽  
W. Ketcherside ◽  
M. E. Patterson
Keyword(s):  
Heart Failure ◽  
Electronic Health Record ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Incidence Rates ◽  
Health Record ◽  
Medicare Beneficiaries ◽  
Readmission Rates ◽  
Heart Failure Patients ◽  
Electronic Health

SummaryBackground: Regulatory standards for 30-day readmissions incentivize hospitals to improve quality of care. Implementing comprehensive electronic health record systems potentially decreases readmission rates by improving medication reconciliation at discharge, demonstrating the additional benefits of inpatient EHRs beyond improved safety and decreased errors.Objective: To compare 30-day all-cause readmission incidence rates within Medicare fee-for-service with heart failure discharged from hospitals with full implementation levels of comprehensive EHR systems versus those without.Methods: This retrospective cohort study uses data from the American Hospital Association Health IT survey and Medicare Part A claims to measure associations between hospital EHR implementation levels and beneficiary readmissions. Multivariable Cox regressions estimate the hazard ratio of 30-day all-cause readmissions within beneficiaries discharged from hospitals implementing comprehensive EHRs versus those without, controlling for beneficiary health status and hospital organizational factors. Propensity scores are used to account for selection bias.Results: The proportion of heart failure patients with 30-day all-cause readmissions was 30%, 29%, and 32% for those discharged from hospitals with full, some, and no comprehensive EHR systems. Heart failure patients discharged from hospitals with fully implemented comprehensive EHRs compared to those with no comprehensive EHR systems had equivalent 30-day readmission incidence rates (HR = 0.97, 95% CI 0.73 – 1.3)Conclusions: Implementation of comprehensive electronic health record systems does not necessarily improve a hospital’s ability to decrease 30-day readmission rates. Improving the efficiency of post-acute care will require more coordination of information systems between inpatient and ambulatory providers.Citation: Patterson ME, Marken P, Zhong Y, Simon SD, Ketcherside W. Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure. Appl Clin Inf 2014; 5: 670–684http://dx.doi.org/10.4338/ACI-2014-01-RA-0008

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

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

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

Current Disaster Medicine in Japan and the Change Brought by Information Sharing

2019 ◽  
Vol 14 (2) ◽  
pp. 292-302
Author(s):  
Yuji Kondo ◽  
Manabu Ichikawa ◽  
Hisayoshi Kondo ◽  
Yuichi Koido ◽  
Yasuhiro Otomo ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Information Sharing ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Patient Information ◽  
Medical Information ◽  
Disaster Medicine ◽  
Cloud System ◽  
Health Record ◽  
Electronic Health

The biggest agenda in disaster medicine in Japan is considered as the collection and sharing of information. Sharing Information Platform for Disaster Management (SIP4D) is the platform that can connect the information system of each government agency in the event of a disaster. The purpose of the present study is to clarify the damage estimation in a Disaster Medical Assistance Team (DMAT) operation, information sharing within headquarters for disaster control, information for the level of damage in hospital, conditions for a DMAT dispatch request, safest route to reach the operation site, and improvements in patient medical information sharing and to assess the utility of introducing electronic health record by SIP Disaster Resilience: Theme 4. We used the information of SIP4D and Health Crisis and Risk Information Supporting Internet system (H-CRISIS) assistance to clarify the variables. We also examined the utility of using an electronic medical record system at the time of a disaster via creating a patient evacuation medical record cloud system in a 2016 Large-scale disaster drill. We requested Staging Care Unit (SCU) members to enter patient information by using a tablet. In SCUs that were outside the afflicted area, we browsed the electronic medical record on the cloud system and compared the time to send patient information using an electronic medical record in SCU to the time to send the same without using an electronic medical record and examined the superiority of the operation. In the statistical analysis, we used the Wilcoxon rank-sum test by MEPHAS. The significance level was set as P < 0.01. Based on the information for personnel damage estimation through SIP4D, the damage estimates are compiled for each prefecture, secondary medical zone, municipality, and school district. Additionally, it is possible to compile the number of predictive and serious patients per disaster hospital and to display it as a WEB service via the geographic information system (GIS). The information in the headquarters for disaster control is shared and visualized on the map, and thus, it is possible to use common information in each section. Furthermore, hospital damage situation, DMAT dispatch conditions, access route, and safety can also be visualized on the map. With respect to the usefulness of introducing an electronic health record at the time of a disaster, the median time to transfer medical information corresponded to 23.5 min in the group that used electronic health records (8 cases) and 41 min in the group that did not use electronic health records (8 cases). The results indicated a significantly shortened time in the group that used the electronic health record (P = 0.0073). It is ideal to estimate the number of patients and hospital damage from information that can grasp the scale of the disaster, such as intensity of an earthquake, set up appropriate headquarters, calculate the required number of DMATs, and instantaneously determine dispatch means and safety routes accordingly. Furthermore, patient information is digitalized from the point of triage, linked to the medical chart for disaster, managed collectively, and entered into the cloud. It is desirable to share patient information across the country. Based on the medical needs predicted from the information, it is also desirable to calculate the appropriate destination and means of transporting the patient in line with the actual damage situation such as infrastructure and road information. Another goal involves building a system that can calculate the aforementioned measures by using artificial intelligence. SIP4D is recognized as useful in terms of the integration and sharing of disaster information, damage situation, and hazard information gathering. It is assumed that SIP4D will lead to a major change in the existing DMAT operation regime. Additionally, the creation of an electronic medical record at the time of disaster and sharing it on the cloud system decreases the time of handover of a patient’s medical information when medical evacuation to a remote place occurs. It is expected that this can aid in improving the efficiency of the medical support team, and thereby, reduce preventable disaster deaths.

scholarly journals Peranan Electronic Health Record System terhadap Keselamatan Pasien di Perawatan Anak

2020 ◽  
Vol 4 (1) ◽  
pp. 22-27
Author(s):  
Yayah Yayah ◽  
La Ode Abdul Rahman
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Electronic Health Record System ◽  
Health Record ◽  
Record System ◽  
Electronic Health

EHRs merupakan bentuk perkembangan teknologi informasi berupa sistem dokumentasi kesehatan dalam format digital yang dapat memberikan tampilan data otomatis yang mendukung dalam kelengkapan dan keakuratan data yang diharapkan dapat  meningkatkan keselamatan pasien termasuk di perawatan anak. Karena anak merupakan populasi yang rentan dalam isu keselamatan pasien. Tujuan penelitian ini adalah untuk mengetahui peranan EHRs terkait keselamatan pasien di perawatan anak. Penelitian ini menggunakan studi literatur dengan melakukan kajian artikel dan jurnal penelitian yang dicari melalui penelusuran database online yang terbit tahun 2014-2019 dengan kata kunci “electronic health record” OR “electronic medical record” AND “pediatric” AND “patient safety” sebanyak 10 artikel dijadikan bahan analisis utama ditambahkan artikel lainnya sebagai sebagai pendukung pembahasan. Hasil penelitian ini menunjukan bahwa EHRs yang sudah dimodifikasi dengan menampilkan umpan balik tanda waspada berupa sistem peringatan dengan tampilan visual dapat meningkatkan komunikasi yang efektif antar tim kesehatan, memberikan peringatan dalam keamanan dan kewaspadaan obat, serta deteksi dini sepsis pada anak sehingga mendukung pengambilan keputusan untuk melakukan tindakan yang tepat untuk meningkatkan keselamatan pasien. EHRs yang sudah dimodifikasi dengan sistem pendukung berupa sistem peringatan memiliki peranan positif dan efektif dalam meningkatkan keselamatan pasien di perawatan anak.

Securing XML with Role-Based Access Control

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

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

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