There is currently very legitimate pressure to change the function of health information systems to more explicitly serve and support the individual. Concurrently other support services to health, including condition monitoring, social care and intelligent housing, add to the complexity of patient health related data. A paradigm shift is needed, to recognize that many agencies and systems outside as well as within the health sector all work to support the citizen's health, yet the essential integrated view is not being provided, even though much needed not least by the citizen and their agents. Broker technologies can enable this new paradigm. Moreover, a move to identifying the patient's appointments and support services would enable a daily life dimension to be given due weight, and would recognize the patient's viewpoint in wanting to live an ordered life, not one subservient and reactive to the delivery of care by providers.
Through this article, we propose a mixed management of patients' medical records, so as to share responsibilities between the patient and the Medical Practitioner by making Patients responsible for the validation of their administrative information, and MPs responsible for the validation of their Patients' medical information. Our proposal can be considered a solution to the main problem faced by patients, health practitioners and the authorities, namely the gathering and updating of administrative and medical data belonging to the patient in order to accurately reconstitute a patient's medical history. This method is based on two processes. The aim of the first process is to provide a patient's administrative data, in order to know where and when the patient received care (name of the health structure or health practitioner, type of care: out patient or inpatient). The aim of the second process is to provide a patient's medical information and to validate it under the accountability of the Medical Practitioner with the help of the patient if needed. During these two processes, the patient's privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows pseudonymisation of a patient's identity. The proposed Medical Record Search Engines will be able to retrieve and to provide upon a request formulated by the Medical Practitioner all the available information concerning a patient who has received care in different health structures without divulging the patient's identity. Our method can lead to improved efficiency of personal medical record management under the mixed responsibilities of the patient and the MP.
Eleni Mytilinaiou, Vassiliki Koufi, Flora Malamateniou, George Vassilacopoulos
201 - 213
Healthcare delivery is a highly complex process involving a broad range of healthcare services, typically performed by a number of geographically distributed and organizationally disparate healthcare providers requiring increased collaboration and coordination of their activities in order to provide shared and integrated care. Under an IT-enabled, patient-centric model, health systems can integrate care delivery across the continuum of services, from prevention to follow-up, and also coordinate care across all settings. In particular, much potential can be realized if cooperation among disparate healthcare organizations is expressed in terms of cross-organizational healthcare processes, where information support is provided by means of PHR systems. This paper assumes a process-oriented PHR system and presents a security framework that addresses the authorization and access control issues arisen in these systems. The proposed framework ensures provision of tight, just-in-time permissions so that authorized users get access to specific objects according to the current context. These permissions are subject to continuous adjustments triggered by the changing context. Thus, the risk of compromising information integrity during task executions is reduced.
With the advent of more sophisticated and comprehensive healthcare information systems, system builders are becoming more interested in patient interaction and what he can do to help to improve his own health care. Information systems play nowadays a crucial and fundamental role in hospital work-flows, thus providing great opportunities to introduce and improve upon “patient empowerment” processes for the personalization and management of Electronic Health Records (EHRs). In this paper, we present a patient's privacy generic control mechanisms scenarios based on the Extended OpenID (eOID), a user centric digital identity provider previously developed by our group, which leverages a secured OpenID 2.0 infrastructure with the recently released Portuguese Citizen Card (CC) for secure authentication in a distributed health information environment. eOID also takes advantage of Oauth assertion based mechanisms to implement patient controlled secure qualified role based access to his EHR, by third parties.
Charles O. Akinyokun, Okure U. Obot, Faith-Michael E. Uzoka, John J. Andy
231 - 244
A neuro-fuzzy decision support system is proposed for the diagnosis of heart failure. The system comprises; knowledge base (database, neural networks and fuzzy logic) of both the quantitative and qualitative knowledge of the diagnosis of heart failure, neuro-fuzzy inference engine and decision support engine. The neural networks employ a multi-layers perception back propagation learning process while the fuzzy logic uses the root sum square inference procedure. The neuro-fuzzy inference engine uses a weighted average of the premise and consequent parameters with the fuzzy rules serving as the nodes and the fuzzy sets representing the weights of the nodes. The decision support engine carries out the cognitive and emotional filtering of the objective and subjective feelings of the medical practitioner. An experimental study of the decision support system was carried out using cases of some patients from three hospitals in Nigeria with the assistance of their medical personnel who collected patients' data over a period of six months. The results of the study show that the neuro-fuzzy system provides a highly reliable diagnosis, while the emotional and cognitive filters further refine the diagnosis results by taking care of the contextual elements of medical diagnosis.
There should be a clear understanding that when implementing an electronic health record system (EHR), one of the hardest problems we have to solve is the access rights. In Estonia this process lasted for three years and involved all stakeholders of the healthcare sector. Special ethical committee was established to advise the decision makers and doctors to help them understand the ethical dilemmas from the patient's and society's point of view. In this article you will find a short overview of the access rights of the system, roles of the healthcare systems' employees. Descriptions of some specific situations like underage patients and representation of patient with restricted active legal capacity.