Impact of Laboratory Value Flowsheet in Electronic Health Record (EHR) Documentation Time

Research on the use of EHR is contradictory since it presents contradicting results regarding the time spent documenting. There is research that supports the use of electronic records as a tool to speed documentation;and research that found that it is time consuming. The purpose of this quantitative retrospective before-after project was to measure the impact of using the laboratory value flowsheet within the EHR on documentation time. The research question was: “Does the use of a laboratory value flowsheet in the EHR impact documentation time by primary care providers (PCPs)?” The theoretical framework utilized in this project was the Donabedian Model. The population in this research was the two PCPs in a small primary care clinic in the northwest of Puerto Rico. The sample was composed of all the encounters during the months of October 2019 and December 2019. The data was obtained through data mining and analyzed using SPSS 27. The evaluative outcome of this project is that there is a decrease in documentation time after implementation of the use of the laboratory value flowsheet in the EHR. However, patients per day increase therefore having an impact on the number of patients seen per day/week/month. The implications for clinical practice include the use of templates to improve workflow and documentation as well as decreasing documentation time while also increasing the number of patients seen per day. .

Data Masking for Chinese Electronic Medical Records with Named Entity Recognition

With the rapid development of information technology,the electronifi-cation of medical records has gradually become a trend.In China,the population base is huge and the supporting medical institutions are numerous,so this reality drives the conversion of paper medical records to electronic medical records.Electronic medical records are the basis for establishing a smart hospital and an important guarantee for achieving medical intelligence,and the massive amount of electronic medical record data is also an important data set for conducting research in the medical field.However,electronic medical records contain a large amount of private patient information,which must be desensitized before they are used as open resources.Therefore,to solve the above problems,data masking for Chinese electronic medical records with named entity recognition is proposed in this paper.Firstly,the text is vectorized to satisfy the required format of the model input.Secondly,since the input sentences may have a long or short length and the relationship between sentences in context is not negligible.To this end,a neural network model for named entity recognition based on bidirectional long short-term memory(BiLSTM)with conditional random fields(CRF)is constructed.Finally,the data masking operation is performed based on the named entity recog-nition results,mainly using regular expression filtering encryption and principal component analysis(PCA)word vector compression and replacement.In addi-tion,comparison experiments with the hidden markov model(HMM)model,LSTM-CRF model,and BiLSTM model are conducted in this paper.The experi-mental results show that the method used in this paper achieves 92.72%Accuracy,92.30%Recall,and 92.51%F1_score,which has higher accuracy compared with other models.

Deletion and Recovery Scheme of Electronic Health Records Based onMedical Certificate Blockchain

The trusted sharing of Electronic Health Records(EHRs)can realize the efficient use of medical data resources.Generally speaking,EHRs are widely used in blockchain-based medical data platforms.EHRs are valuable private assets of patients,and the ownership belongs to patients.While recent research has shown that patients can freely and effectively delete the EHRs stored in hospitals,it does not address the challenge of record sharing when patients revisit doctors.In order to solve this problem,this paper proposes a deletion and recovery scheme of EHRs based on Medical Certificate Blockchain.This paper uses cross-chain technology to connect the Medical Certificate Blockchain and the Hospital Blockchain to real-ize the recovery of deleted EHRs.At the same time,this paper uses the Medical Certificate Blockchain and the InterPlanetary File System(IPFS)to store Personal Health Records,which are generated by patients visiting different medical institutions.In addition,this paper also combines digital watermarking technology to ensure the authenticity of the restored electronic medical records.Under the combined effect of blockchain technology and digital watermarking,our proposal will not be affected by any other rights throughout the process.System analysis and security analysis illustrate the completeness and feasibility of the scheme.

Machine-Learning-Enabled Obesity Level Prediction Through Electronic Health Records

Obesity is a critical health condition that severely affects an individual’s quality of life andwell-being.The occurrence of obesity is strongly associated with extreme health conditions,such as cardiac diseases,diabetes,hypertension,and some types of cancer.Therefore,it is vital to avoid obesity and or reverse its occurrence.Incorporating healthy food habits and an active lifestyle can help to prevent obesity.In this regard,artificial intelligence(AI)can play an important role in estimating health conditions and detecting obesity and its types.This study aims to see obesity levels in adults by implementing AIenabled machine learning on a real-life dataset.This dataset is in the form of electronic health records(EHR)containing data on several aspects of daily living,such as dietary habits,physical conditions,and lifestyle variables for various participants with different health conditions(underweight,normal,overweight,and obesity type I,II and III),expressed in terms of a variety of features or parameters,such as physical condition,food intake,lifestyle and mode of transportation.Three classifiers,i.e.,eXtreme gradient boosting classifier(XGB),support vector machine(SVM),and artificial neural network(ANN),are implemented to detect the status of several conditions,including obesity types.The findings indicate that the proposed XGB-based system outperforms the existing obesity level estimation methods,achieving overall performance rates of 98.5%and 99.6%in the scenarios explored.

Ensuring Information Security in Electronic Health Record System Using Cryptography and Cuckoo Search Algorithm

In the contemporary era,the abundant availability of health information through internet and mobile technology raises concerns.Safeguarding and maintaining the confidentiality of patients’medical data becomes paramount when sharing such information with authorized healthcare providers.Although electronic patient records and the internet have facilitated the exchange of medical information among healthcare providers,concerns persist regarding the security of the data.The security of Electronic Health Record Systems(EHRS)can be improved by employing the Cuckoo Search Algorithm(CS),the SHA-256 algorithm,and the Elliptic Curve Cryptography(ECC),as proposed in this study.The suggested approach involves usingCS to generate the ECCprivate key,thereby enhancing the security of data storage in EHR.The study evaluates the proposed design by comparing encoding and decoding times with alternative techniques like ECC-GA-SHA-256.The research findings indicate that the proposed design achieves faster encoding and decoding times,completing 125 and 175 iterations,respectively.Furthermore,the proposed design surpasses other encoding techniques by exhibiting encoding and decoding times that are more than 15.17%faster.These results imply that the proposed design can significantly enhance the security and performance of EHRs.Through the utilization of CS,SHA-256,and ECC,this study presents promising methods for addressing the security challenges associated with EHRs.

Using AI and Precision Nutrition to Support Brain Health during Aging

Artificial intelligence, often referred to as AI, is a branch of computer science focused on developing systems that exhibit intelligent behavior. Broadly speaking, AI researchers aim to develop technologies that can think and act in a way that mimics human cognition and decision-making [1]. The foundations of AI can be traced back to early philosophical inquiries into the nature of intelligence and thinking. However, AI is generally considered to have emerged as a formal field of study in the 1940s and 1950s. Pioneering computer scientists at the time theorized that it might be possible to extend basic computer programming concepts using logic and reasoning to develop machines capable of “thinking” like humans. Over time, the definition and goals of AI have evolved. Some theorists argued for a narrower focus on developing computing systems able to efficiently solve problems, while others aimed for a closer replication of human intelligence. Today, AI encompasses a diverse set of techniques used to enable intelligent behavior in machines. Core disciplines that contribute to modern AI research include computer science, mathematics, statistics, linguistics, psychology and cognitive science, and neuroscience. Significant AI approaches used today involve statistical classification models, machine learning, and natural language processing. Classification methods are widely applicable to problems in various domains like healthcare, such as informing diagnostic or treatment decisions based on patterns in data. Dean and Goldreich, 1998, define ML as an approach through which a computer has to learn a model by itself from the data provided but no specification on the sort of model is provided to the computer. They can then predict values for things that are different from the values used in training the models. NLP looks at two interrelated concerns, the task of training computers to understand human languages and the fact that since natural languages are so complex, they lend themselves very well to serving a number of very useful goals when used by computers.

Secure approach to sharing digitized medical data in a cloud environment

Without proper security mechanisms, medical records stored electronically can be accessed more easily than physical files. Patient health information is scattered throughout the hospital environment, including laboratories, pharmacies, and daily medical status reports. The electronic format of medical reports ensures that all information is available in a single place. However, it is difficult to store and manage large amounts of data. Dedicated servers and a data center are needed to store and manage patient data. However, self-managed data centers are expensive for hospitals. Storing data in a cloud is a cheaper alternative. The advantage of storing data in a cloud is that it can be retrieved anywhere and anytime using any device connected to the Internet. Therefore, doctors can easily access the medical history of a patient and diagnose diseases according to the context. It also helps prescribe the correct medicine to a patient in an appropriate way. The systematic storage of medical records could help reduce medical errors in hospitals. The challenge is to store medical records on a third-party cloud server while addressing privacy and security concerns. These servers are often semi-trusted. Thus, sensitive medical information must be protected. Open access to records and modifications performed on the information in those records may even cause patient fatalities. Patient-centric health-record security is a major concern. End-to-end file encryption before outsourcing data to a third-party cloud server ensures security. This paper presents a method that is a combination of the advanced encryption standard and the elliptical curve Diffie-Hellman method designed to increase the efficiency of medical record security for users. Comparisons of existing and proposed techniques are presented at the end of the article, with a focus on the analyzing the security approaches between the elliptic curve and secret-sharing methods. This study aims to provide a high level of security for patient health records.

Digital Continuity Guarantee Approach of Electronic Record Based on Data Quality Theory

Since the British National Archive put forward the concept of the digital continuity in 2007,several developed countries have worked out their digital continuity action plan.However,the technologies of the digital continuity guarantee are still lacked.At first,this paper analyzes the requirements of digital continuity guarantee for electronic record based on data quality theory,then points out the necessity of data quality guarantee for electronic record.Moreover,we convert the digital continuity guarantee of electronic record to ensure the consistency,completeness and timeliness of electronic record,and construct the first technology framework of the digital continuity guarantee for electronic record.Finally,the temporal functional dependencies technology is utilized to build the first integration method to insure the consistency,completeness and timeliness of electronic record.

Long-Term Preservation of Electronic Record Based on Digital Continuity in Smart Cities

Under the co-promotion of the wave of urbanization and the rise of data science,smart cities have become the new concept and new practice of urban development.Smart cities are the combination of information technology represented by the Internet of Things,cloud computing,mobile networks and big data,and urbanization.How to effectively achieve the long-term preservation of massive,heterogeneous,and multi-source digital electronic records in smart cities is a key issue thatmust be solved.Digital continuity can ensure the accessibility,integrity and availability of information.The quality management of electronic record,like the quality management of product,will run through every phase of the urban lifecycle.Based on data quality management,this paper constructs digital continuity of smart city electronic records.Furthermore,thework in this paper ensures the authenticity,integrity,availability and timeliness of electronic documents by quality management of electronic record.This paper elaborates on the overall technical architecture of electronic record,as well as the various technical means needed to protect its four characteristics.

A Secure Signcryption Scheme for Electronic Health Records Sharing in Blockchain

In the existing Electronic Health Records(EHRs),the medical information of patients is completely controlled by various medical institutions.As such,patients have no dominant power over their own EHRs.These personal data are not only inconvenient to access and share,but are also prone to cause privacy disclosure.The blockchain technology provides a new development direction in the medical field.Blockchain-based EHRs are characterized by decentralization,openness and non-tampering of records,which enable patients to better manage their own EHRs.In order to better protect the privacy of patients,only designated receivers can access EHRs,and receivers can authenticate the sharer to ensure that the EHRs are real and effective.In this study,we propose an identity-based signcryption scheme with multiple authorities for multiple receivers,which can resist N-1 collusion attacks among N authorities.In addition,the identity information of receivers is anonymous,so the relationship between them and the sharer is not disclosed.Under the random oracle model,it was proved that our scheme was secure and met the unforgeability and confidentiality requirements of signcryption.Moreover,we evaluated the performance of the scheme and found that it had the moderate signcryption efficiency and excellent signcryption attributes.

Hyperledger Fabric Blockchain: Secure and Efficient Solution for Electronic Health Records

Background:Electronic Health Record(EHR)systems are used as an efficient and effective technique for sharing patient’s health records among different hospitals and various other key stakeholders of the healthcare industry to achieve better diagnosis and treatment of patients globally.However,the existing EHR systems mostly lack in providing appropriate security,entrusted access control and handling privacy and secrecy issues and challenges in current hospital infrastructures.Objective:To solve this delicate problem,we propose a Blockchain-enabled Hyperledger Fabric Architecture for different EHR systems.Methodology:In our EHR blockchain system,Peer nodes from various organizations(stakeholders)create a ledger network,where channels are created to enable secure and private communication between different stakeholders on the ledger network.Individual patients and other stakeholders are identified and registered on the network by unique digital certificates issued by membership service provider(MSP)component of the fabric architecture.Results:We created and implemented different Chaincodes to handle the business logic for executing separate EHR transactions on the network.The proposed fabric architecture provides a secure,transparent and immutable mechanism to store,share and exchange EHRs in a peer-to-peer network of different healthcare stakeholders.It ensures interoperability,scalability and availability in adapting the existing EHRs for strengthening and providing an effective and secure method to integrate and manage patient records among medical institutions in the healthcare ecosystem.

Effect of Electronic Medical Record Utilization on Depression, Anxiety and Stress among Doctors and Nurses in Johor, Malaysia

Background： The usage of modem technology in healthcare record system is now a must throughout the world. However, many doctors and nurses has been reporting facing numerous challenges and obstacles in the implementation. The aim of the present study is to determine the prevalence of depression, anxiety and stress among doctors and nurses who utilize EMR （electronic medical record） and its associated factor. Methods： A comparative cross-sectional study was conducted ~om January till April 2012 among doctors and nurses in two public tertiary hospitals in Johor in which one of them uses EMR and the other one still using the MMR （manual medical record） system. Data was collected using self-administered validated Malay version of DASS-21 （Depression, Anxiety, and Stress Scales-21） items questionnaire. It comprises of socio-demographic and occupational characteristics. Findings： There were 130 respondents with a response rate of 91% for EMR and 123 respondents with a response rate of 86% for MMR. The mean （SD） age of respondents in EMR and MMR groups were 34.7 （9.42） and 29.7 （6.15） respectively. The mean （SD） duration of respondents using EMR was 46.1 （35.83） months. The prevalence of depression, anxiety and stress among respondents using EMR were 6.9%, 25.4% and 12.3%. There were no significant difference between the study groups related to the depression, anxiety and stress scores. In multivariable analysis, the significant factors associated with depression among respondents using EMR was age （OR 1.10, 95% CI 1.02, 1.19）. The significant factors associated with stress among respondents using EMR was marital status （OR 3.33, 95% CI 1.10, 10.09） and borderline significant was computer skill course （OR 2.94, 95% CI 0.98, 8.78）. Conclusion： The prevalence of depression, anxiety and stress of those who uses EMR were within acceptable range. Age, marital status and computer skill are the identified factor associated with the depression and stress level which need to be considered in its implementation.

Maturity Assessment of Hospital Information Systems Based on Electronic Medical Record Adoption Model (EMRAM)— Private Hospital Cases in Iran

Introduction: Today, information technology is considered as an important national development principle in each country which is applied in different fields. Health care as a whole and the hospitals could be regarded as a field and organizations with most remarkable IT applications respectively. Although different benchmarks and frameworks have been developed to assess different aspects of Hospital Information Systems (HISs) by various researchers, there is not any suitable reference model yet to benchmark HIS in the world. Electronic Medical Record Adoption Model (EMRAM) has been currently presented and is globally well-known to benchmark the rate of HIS utilization in the hospitals. Notwithstanding, this model has not been introduced in Iran so far. Methods: This research was carried out based on an applied descriptive method in three private hospitals of Isfahan—one of the most important provinces of Iran—in the year 2015. The purpose of this study was to investigate IT utilization stage in three selected private hospitals. Conclusion: The findings revealed that HIS is not at the center of concern in studied hospitals and is in the first maturity stage in accordance with EMRAM. However, hospital managers are enforced and under the pressure of different beneficiaries including insurance companies to improve their HIS. Therefore, it could be concluded that these types of hospitals are still far away from desirable conditions and need to enhance their IT utilization stage significantly.

Optimising workflow in andrology: a new electronic patient record and database

Aim： To improve workflow and usability by introduction of a new electronic patient record （EPR） and database. Methods： Establishment of an EPR based on open source technology （MySQL database and PI-IP scripting language） in a tertiary care andrology center at a university clinic. Workflow analysis, a benchmark comparing the two systems and a survey for usability and ergonomics were carried out. Results： Workflow optimizations （electronic ordering of laboratory analysis, elimination of transcription steps and automated referral letters） and the decrease in time required for data entry per patient to 71% ± 27%, P 〈 0.05, lead to a workload reduction. The benchmark showed a significant performance increase （highest with starting the respective system： 1.3 ± 0.2 s vs. 11.1 ± 0.2 s, mean ± SD）. In the survey, users rated the new system at least two ranks higher over its predecessor （P 〈 0.01） in all sub-areas. Conclusion： With further improvements, today＇s EPR can evolve to substitute paper records, saving time （and possibly costs）, supporting user satisfaction and expanding the basis for scientific evaluation when more data is electronically available. Newly introduced systems should be versatile, adaptable for users, and workflow-oriented to yield the highest benefit. If ready-made software is purchased, customization should be implemented during rollout. （Asian J Andro12006 Mar; 8： 235-241）

Secure Provenance of Electronic Records Based on Blockchain

At present,the provenance of electronic records is stored centrally.The centralized way of information storage has huge risks.Whether the database itself is destroyed or the communication between the central database and the external interruption occurs,the provenance information of the stored electronic records will not play its role.At the same time,uncertainties such as fires and earthquakes will also pose a potential threat to centralized databases.Moreover,the existing security provenance model is not specifically designed for electronic records.In this paper,a security provenance model of electronic records is constructed based on PREMIS and METS.Firstly,this paper analyses the security requirements of the provenance information of electronic records.Then,based on the characteristics of blockchain decentralization,and combined with coding theory,a distributed secure provenance guarantees technology of electronic records is constructed,which ensures the authenticity,integrity,confidentiality and reliability of the provenance information.

Nursing decision support system:application in electronic health records

The clinical decision support system makes electronic health records(EHRs)structured,intelligent,and knowledgeable.The nursing decision support system(NDSS)is based on clinical nursing guidelines and nursing process to provide intelligent suggestions and reminders.The impact on nurses’work is mainly in shortening the recording time,improving the quality of nursing diagnosis,reducing the incidence of nursing risk events,and so on.However,there is no authoritative standard for the NDSS at home and abroad.This review introduces development and challenges of EHRs and recommends the application of the NDSS in EHRs,namely the nursing assessment decision support system,the nursing diagnostic decision support system,and the nursing care planning decision support system(including nursing intervene),hoping to provide a new thought and method to structure impeccable EHRs.

Front-end Control Mechanism of Electronic Records

In the digital era,how to ensure the authenticity and integrity of elec-tronic records has become an open challenging issue.Front-end control is an important concept as well as a basic principle in electronic record management.Under the instruction of front-end control,many original management links in the record-management stage are required to move forward,and the managers enter the formation stage of the electronic records to ensure the originality.How-ever,the front-end control technique primarily focuses on transaction manage-ment,and it lacks the strategy of providing the control of electronic records.In this paper,a novel electronic record front-end control mechanism is proposed by adopting proxy re-encryption and requiring archivists to participate in the man-agement of electronic records before the record is created to solve the problem.Specifically,when an electronic record is generated,the proposed mechanism interacts with the producer of the electronic record to generate a corresponding encryption key.Moreover,electronic records are encrypted by the key to protect their confidentiality,which can prevent the leakage of electronic record informa-tion.In addition,when transferring the electronic record,archivists use proxy re-encryption technology to convert electronic records,allowing management by an archivist,ensuring their originality and authenticity.

Correlation between an Independent Electronic Health Record &External Ranking of Children’s Hospitals

Introduction: To evaluate the correlation between the presence of an independent EHR (compared to a shared EHR system within an adult hospital system) and an externally-derived third party ranking of children’s hospitals. Methods: Children’s hospitals that ranked in the top fifty of the 2019-2020 US News and World Report (USNWR) were included in the analysis. The mean and median ranking of children’s hospitals with independent versus a shared EHR was evaluated. The 2019-2020 USNWR rankings of the top twenty adult hospitals in the United States were then evaluated. For each children’s hospital with an associated adult hospital that was both ranked, it was noted as to whether the EHR for the children’s hospital was independent or shared and statistical differences in rankings compared. Results: Among the top 50 children’s hospitals included, the median USNWR ranking for hospitals was statistically different with an independent EHR than with a shared EHR (13 vs. 30.0) (p = 0.002). The 21 top ranked adult hospitals were associated with 17 children’s hospitals ranked in the top 50. The median ranking for those with an independent EHR was statistically different for those with independent EHR versus shared EHR (7 vs. 28) (p = 0.002). Conclusion: Children’s hospitals with an independent EHR are associated with higher scores on an independent external ranking of hospital quality compared to those which share an EHR with a partner adult hospital.

Ensuring Readability of Electronic Records Based on Virtualization Technology in Cloud Storage

With the rapid development of E-commerce and E-government, there are somany electronic records have been produced. The increasing number of electronicrecords brings about storage difficulties, the traditional electronic records center isdifficult to cope with the current fast growth requirements of electronic records storageand management. Therefore, it is imperative to use cloud storage technology to buildelectronic record centers. However, electronic records also have weaknesses in the cloudstorage environment, and one of them is that once electronic record owners or managerslose physical control of them, the electronic records are more likely to be tampered withand destroyed. So, the paper builds a reliable electronic records preservation systembased on coding theory. It can effectively guarantee the reliability of record storage whenthe electronic record is damaged, and the original electronic record can be restored byredundant coding, thus ensuring the reliable storage of electronic records.

Preservation Mechanism of Network Electronic Records Based on Broadcast-Storage Network in Urban Construction

With the wide application of information technology in urban infrastructure,urban construction has entered the stage of smart city,forming a large number of network electronic records.These electronic records play a vital role in the maintenance of urban infrastructure.However,how to preserve the network electronic records in the field of urban construction is still lack of a comprehensive and serious study.Aiming at this problem,the paper proposes to use the technology of broadcast-storage network to preserve the network electronic records for a long time and gives the concrete preservation process.