Design Issues for Electronics Health Records Using Cloud Computing Technologies

Size: px

Start display at page:

Download "Design Issues for Electronics Health Records Using Cloud Computing Technologies"

Henry Fleming
6 years ago
Views:

1 IEEE Conference on Professional Development & Latest Trends in Emerging Topics for Practicing Engineers Nov. 8-9, Indianapolis Marriott East Organized by IEEE Central Indiana Section/Computer Society Chapter Design Issues for Electronics Health Records Using Cloud Computing Technologies Sayed Hassan, Interactive Intelligence, Paul I-Hai Lin, Department of Computer, Electrical, and Information Technology, Indiana University-Purdue University Fort Wayne 1 Design Issues for Electronics Health Records Using Cloud Computing Technologies Topics of Discussion An Introduction to HealthIT and EHR Definitions: EHR (Electronic Health Record), EMR, Cloud Computing Previous Research in EHR Interoperability and Health Information System Integration Cloud-Based EHR System Architecture Design Issues A Windows Azure-Based EHR Case Study Conclusion 2 1

2 Introduction The integration of EHR in IT infrastructures supporting organizations enable Improved access and recording of patient data Enhanced ability to make improved decisions, Improved quality and Reduced errors in patient care. Research has shown that the healthcare industry is plagued by Rapidly increasing costs, Poor quality of service, Lack of integration of patient care, and Lack of information access to Electronic Health Records 3 (EHR) World-Wide Healthcare Spending and GDP Ratio [1] 4 2

3 Definitions EHR (Electronics Health Record), The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. EHR includes patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other carerelated activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting. 5 An Example EHR [2] 6 3

4 EMRs and EHRs [3] EMR (Electronic Medical Record) EHR Definition The legal record of clinical services for a patient within a Care Delivery Organization (CDO) A subset of EMR from one or more CDOs where the patient received clinical services Ownership Owned by the CDO Owned by patient or stakeholder Consumer & Usage Supplied by enterprise vendors and installed by hospitals, health systems, clinics, etc Run are community, state, or regional health related organizations 7 EMRs and EHRs [3] (cont.) Right of Patient Interoperability with other CDOs EMR (Electronic Medical Record) Patients can gain access to some EMR info authorized by the EMR owners Each EMR contains only the patient s info encountered in a single CDO. EHR Provided with interactive access as well as the ability to append information Sharing information among multiple CDOs, connected by National Health Information Network (NHIN) 8 4

5 Emergence of Cloud Computing The emergence of cloud computing services provides users with flexible access, large storage capability and low costs, However, securing EHRs in cloud is a major challenge. Several security properties need to be satisfied, such as data privacy fine-grained access control and scalable access between different clouds 9 Emergence of Cloud Computing Options of EHR in Cloud Applications in the cloud (Software as a Service SaaS). Infrastructure in the cloud (Infrastructure as a Service IaaS) Platforms in the cloud (Platform as a service PaaS) 10 5

Cloud-based EHR System Architecture Design and Issues EHR System Life Cycle Requirements, Analysis, Design, Testing, and Installation Storage Requirements Communication &

6 Cloud-based EHR System Architecture Design and Issues EHR System Life Cycle Requirements, Analysis, Design, Testing, and Installation Storage Requirements Communication & Networking Bandwidth Requirements Fault Tolerance and System Availability Security and Privacy Government Laws and Regulations 11 System Design: Patient-Provider Interaction 12 6

7 SOAbased Design [4] 13 System Design: Understand Primary Patient-Care Provide Interaction Process [4] 14 7

Services EHR Business Rules Services 15 System Design: EHR

8 System Design: EHR Service Candidates (SOA-approach) [4] EHR Access Services EHR Update Services EHR Process Orchestration Services EHR Business Rules Services 15 System Design: EHR Service Identification [4] InsertPatient GetPatient UpdatePatient 16 8

9 Cloud-Based HER Design SaaS-based EHR IaaS-based EHR Cloud Storage of EHR PaaS-based EHR 17 Cloud-Based EHR vs. Client/Server Design Consideration Features 1. Location of system code and execution Infrastructure Type EHR in a Cloud Client/Server Remote, usually at vendor s premise Local, usually at clinical office/hospitals 2. Control of System Data 3. System migration and/or scalability in future, assuming the same vendor is used Less control Easier More control Harder and more complex 18 9

10 Cloud-Based EHR vs. Client/Server Design Consideration (cont.) Features 4. Security (for small clinics with limited tech support & computer resources) 5. Hardware Requirements Infrastructure Type EHR in a Cloud Client/Server More security Less security Fewer More 6. Response time Dependent upon Internet service, provider, network provisioning, and HER vendors Dependent upon system maintenance and configuration 19 Cloud-Based EHR vs. Client/Server Design Consideration (cont.) Features 7. Remote access via Internet Infrastructure Type EHR in a Cloud Client/Server Easy 8. Maintenance Easier Harder Possible, but security measures are needed t protect EHR servers 9. Data synchronization for clinic with multiple offices Easier Harder 20 10

Cloud-Based EHR vs. Client/Server Design Consideration (cont.) Features 10. Data backup and disaster recovery Infrastructure Type EHR in a Cloud Client/Server Easies and cheaper 11.

11 Cloud-Based EHR vs. Client/Server Design Consideration (cont.) Features 10. Data backup and disaster recovery Infrastructure Type EHR in a Cloud Client/Server Easies and cheaper 11. Initial cost Lower Higher Extra expenses and technical support are required 12. Total life-cycle cost (3-5 years) Lower Higher 21 Previous Research: EHR Data Interoperability and Interoperable Platforms) [4][5] Platform independent data formatting and architectural Enables automatic data exchange between care sits The needs of Standards Data structure, Messaging and Communication, Architecture, Clinical Documents, Semantic Content, Security, Business requirements, etc 22 11

12 EHR Standards HL7, EHRCom DICOM (Digital Imaging and Communications in Medicine), Visualization Format Signing Popularity HL7 CDA + XML EHR Com - XML - ++ DICOM SR - Binary Cloud-based EHR System Architecture Design and Issues EHR System Life Cycle Requirements, Analysis, Design, Testing, and Installation Storage Requirements Privacy & Security Achieving HIPPA regulatory compliance through data centers with bank-level security and highlevel encryption methods 24 12

13 Cloud-based EHR System Architecture Design and Issues EHR System Life Cycle Storage Requirements Communication & Networking Bandwidth Requirements (Factors to Consider) Number of users User locations Real-time transactions Hardware Storage technology 25 Cloud-based EHR System Architecture Design and Issues Fault Tolerance and System Availability System Availability = MTTF/(MTTF + MTTR) MTTF Mean Time to Failure; MTTR Mean Time to Repair Unplanned hardware, software, network components failures Planned shutdown Partial vs. total failure Cloud system tolerance to system failures Hot Standby Server Clusters Active Takeover Clusters Failover Cluster Recovery Schemes: Backward recovery, Roll Back, Forward Recovery 26 13

14 Security Threats and Responsibility [6] 27 Cloud-based EHR System Architecture Design and Issues EHR System Life Cycle Storage Requirements Communication & Networking Bandwidth Requirements Fault Tolerance and System Availability Security and Privacy Government Laws and Regulations 28 14

15 Key Tasks Review Patient History Displays available history and demographics Conduct Prompt for Patient required assessme information nt Determin e Clinical Decision Develop treatment plan Order Additiona l Services EHR Role EMR system functionality Memory Computation Decision Support Collaboration Provides Recommend care based Contextual on patient view of characteristics. overall patient health Relate assessment to patient history Standards of care, care plans, evidence based guidelines Review previous services/ results Prescribe Medications Medicatio history, allergies, ns formulary Documen t Visit Diagnosis and treatment codes Compute Statistics (BMI etc.) Display trends, reference ranges Apply Standards of care based on patient characteristic s Determine appropriate provider / location Dose Calculation Prompts/aut omatic population Action oriented clinical reminders Support based on outside research/ recommendations Evidence based care adjusted by patient characteristics Alignment with insurance requirements Interactions, contraindications, effectiveness Insurance guidelines Incorporate information from outside sources Coordinate across multiple providers. Staff views/instructions Patient Summary, educational tools Create referrals, facilitate provider communication Patient Instructions side effects and warnings 29 Patient Education, coordination with multiple Providers. A Case Study of an Windows Azure-based EHR with Android Mobile Apps 30 15

16 Windows Azure Platform Filtering Routers Firewalls Cryptographic Protection of Messages Monitoring Network Segmentation 31 Practice Fusion (free web based HER hosted on Cloud) 32 16

17 Conclusion An Introduction to HealthIT and EHR Definitions: EHR (Electronic Health Record), EMR, Cloud Computing Previous Research in EHR Interoperability and Health Information System Integration Cloud-Based EHR System Architecture Design Issues A Windows Azure-Based EHR Case Study 33 References 1. America s Stunningly Overpriced Healthcare System in 2 Charts, Business Insider. [Online]. Available: [Accessed: 03-Dec-2012]. 2. Sahavechaphan, N.; U-ruekolan, S.; Harnsamut, N.; Phengsuwan, J.; Aroonrua, K.;, "An efficient technique for aspect-based EHR access policy administration on ABAC," ICT and Knowledge Engineering (ICT & Knowledge Engineering), th International Conference on, vol., no., pp.27-33, Jan EMR vs HER What is the Difference?, 4. EHR Interoperability in the U.S. based on the HL7 and CDA and SOA Methods, M.S. Directed Project Report, Joshua Prowant, Paul Lin (Advisor), May

18 References 5. A Study of an Integrated Healthcare Information System, M.S. Directed Project Report, Elhadi Eloma, Paul Lin (Advisor), May Design Issues for Electronic Health Record Using Cloud Computing Technologies, Sayed Nayab Hassan, Paul Lin (Advisor), Spring. 7. K. Hwang, F. C. Geoffrey and J. J. Dongarra, Distributed and Cloud Computing From Parallel processing to internet of things, Newyork: Elsevier,

CHAPTER 6 DESIGN AND ARCHITECTURE OF REAL TIME WEB-CENTRIC TELEHEALTH DIABETES DIAGNOSIS EXPERT SYSTEM

87 CHAPTER 6 DESIGN AND ARCHITECTURE OF REAL TIME WEB-CENTRIC TELEHEALTH DIABETES DIAGNOSIS EXPERT SYSTEM 6.1 INTRODUCTION This chapter presents the design and architecture of real time Web centric telehealth