The Colorectal Cancer Survivor’s PersonalHealthRecord (CRCS-PHR) was developed by adapting an open-source electronichealthrecord (OpenMRS)  to deliver an online survivorship care plan to CRC survivors. The chosen features of the CRCS-PHR were drawn from an Institute of Medicine report, which recommended that every cancer patient receive a survivorship care plan summarizing information important to the individual’s long-term care . This information includes a treatment summary, type of cancer and treatments, and a survivorship care plan consisting of potential side effects of treatment and specific information about the recommended follow-up (surveillance) care. In the development of the CRCS-PHR, the guiding principle when making design decisions was patient centeredness; consistent with this approach, we created a technology to make medical information accessible to the patient, empower the patient to manage information through decision-support tools, and allow the patient to control whom the information would be shared with. Table 1 summarizes the functions of the CRCS-PHR (see Multimedia Appendix 1 for further details).
In this section, we discuss one of the big issues that hinder information exchange among different healthcare systems. PersonalHealthRecord System (PHRS) and ElectronicHealthRecord (EHR) are independent systems with the purpose of providing the right clinical information to the caregivers at right time to ensure quality care while allowing patients to monitor their own health. In PHRS, patients have full control over their PHRs. However, in PHRS, patients are concerned about their clinical data privacy and are not willing to share their health data with others, which makes it difficult for doctors to provide them the right treatment especially in emergency situations. According to the Institute of Medicine “poor communication and exchange of medical information at transition points for patients from one provider to another are responsible for many medical errors and adverse drug events”. According to the Healthcare IT news, preventable medical error is considered to be the third killer after heart disease and cancer in the US which cause the death rate of 400,000 people each year. From the patient perspective, there is no systematic way to share their clinical data in the PHR with their physicians due to reliability concern. On the other hand, in EHR systems, the data can be shared with many related agencies (e.g. insurance companies, pharmacies, etc.) each of which keeps a part of the patients’ records based on their specialties. However, EHR systems are developed by independent vendors and designed to meet their customers’ needs. This in turn causes interoperability issues that hinder data exchange between PHRS and EHRS and even between EHRS that were developed by different vendors.The interoperability issues include: data definition (e.g. vocabularies mismatching, size, name, etc.), change of workflow (e.g. new processes, lack of currency, lack of interoperable software, etc.), security and privacy (e.g. authorizing access, data quality, etc.).
The lack of positive (or detrimental) effects may be due to a number of reasons. Both studies may have missed important effects due to the high attrition rates . For example, in Warner et al.’s study 56% of the 90 participants randomised to PHR did not use it at all and were therefore deemed not to benefit from it . Second, the outcome measures might not have been appropriate to identify the costs and benefits. Essex, Doig and Renshaw  showed that patient-held shared care records were acceptable to those with severe men- tal illness and improved autonomy, effectiveness of shared care, and communication with clinicians; none of these outcomes were assessed in either of the RCTs. In their review of patient held records in mental health ser- vices, Laugharne and Stafford  also discovered that patients generally found their notes useful, informative and felt they increased their autonomy. Additionally the authors note that there may be a positive impact on treatment adherence, although they acknowledge the need for a more stringent evaluation of all of these effects . A final explanation for the null results of previous RCTs might be that the patient-held records did not consist of the necessary elements needed to improve patient outcomes. A paper version of the PHR was investigated in Stafford and Laugharne ’ s  study, in which a patient-held care booklet was provided to long-term mental health service users including infor- mation on medications, contact numbers and notes. They found that the vast majority of those in the study viewed the booklet as useful and informative, with parti- cipants frequently citing the most useful information as telephone numbers and medication. Both of these were omitted from Warner et al.’s intervention . Perhaps the most encouraging aspect of Stafford and Laugharne’s design  is that a follow-up study five years later demonstrated that nearly 65% of those interviewed were still using the shared care record, showing naturalistic sustainability .
Results concerning the usability of the tool during the study period are reported in Table 2. Data reported by patients in the questionnaires were in complete agreement with the number of connections to the tool recorded during the study period. The tool was used to update personal records by 19/28 patients (68%), with each of the 19 patients making a median of two connections (range 1–12). In month 3, heterogeneous usage profiles were observed between patients from groups 2 and 3, which were classified as nonadherent (less than two connections), adherent (two connections), or very adherent (at least three connections) in 28%, 40%, and 32%, respectively. Except for being older, no other differences were observed between very adherent and nonadherent patients (mean age 57 versus 44 years respectively, P = 0.04) with regards to their characteristics at inclusion.
In the last decade, PHRs has been widely used to provide diabetic patients with proper set of in- formation needed for their care, and accessibility to their health information (17, 18, 20). Various definitions for PHR have been presented by nu- merous organizations (21, 22). The Healthcare Information and Management Systems Society (HIMSS) defines PHR (21): “as a universally ac- cessible, layperson comprehensible, lifelong tool for managing relevant health information, pro- moting health maintenance and assisting with chronic disease management via an interactive, common data set of electronichealth information and e-health tools”.
According to the HIMSS (Healthcare Information and Management Systems Society) an ePHR is supposed to be “a universally accessible, layperson comprehensible, lifelong tool for managing relevant health information, promoting health maintenance and assisting with chronic disease management via an interactive, common data set of electronichealth information and e-health tools”. It should therefore be operated by the patient himself, aiming at the provision of access to such services for anyone, anywhere and at anytime, through any kind of devices. Such an approach implies an explicit design focus to address diversity, as opposed to reactive or ad hoc approaches, and additional consideration towards redefining the concept of Design for All in the context of Human Computer Interaction . Thus, as an ePHR is a healthrecord that is handled by an individual user himself, it is necessary to make this information accessible online to anyone who has the necessary electronic credentials to view the information.
For successful implementation of mental health smart technologies, in addition to knowing what works well, it is important to understand what needs to be improved. Participants expressed several frustrations about inher- ent aspects of the smartphone and LSR. For example, some individuals identified that the text size and touch screen keyboard made the intervention difficult to use. Future interventions may benefit from allowing a choice of devices to ensure accessibility for all participants. Some participants experienced difficulties remembering passwords or were frustrated by the login process. Previ- ous studies have identified that cognitive impairments can impede one’s ability to use technology . Since the MHEN sample included individuals with a wide range of illness severity and impairments, it is possible that certain aspects of the LSR were too cognitively taxing for some participants. Alternatively, difficulty in remembering passwords may be a function of the perva- siveness of mobile devices and applications requiring passwords, rather than a specific cognitive deficit. There- fore, including a secure login process that does not require the user to remember a password, such as bio- metric identification, may enhance the usability of the LSR for a greater number of people. Further, participants suggested that receiving some information by text or email, such as when a message from a care provider is received, rather than having to login to the LSR, would be useful. These recommendations are consistent with previous research describing how electronic information should best be displayed for individuals with mental
Abstract: The general motivation behind this research is to defeat the spread of malware exercises in several aspects. EHR - ElectronicHealth Records which is the ongoing, patient-centered record system that makes the fundamental data accessible to the approved clients incorporates specialists, patients, and other nursing and clinical institutional for getting to or refreshing the vital data and keeping up them every now and again for the significance in patient consideration. Healthrecord management is the most important and challenging task. Use of innovations in medicinal services framework, especially the utilization of ElectronicHealth Records (EHR) gives a wide assortment of advantages. Better and appropriate healthcare is provided by EHR by improving all aspects of health care. A few verifications are created and associated with protecting the records of the patients and for giving delicate and real information to the patients. In spite of many safeguarding techniques provided, still there is malware capacity and this malware exercise leads in influencing the entire procedure. A worldwide effect from WannaCry malware is one of the transient issues where the greatest information is encoded. This prompts the mishandling of SMB(Server Message Block). The primary point is to defeat the malware. To beat this issue we have proposed an ABE which is the novel - based system for patient-driven secure sharing of EHRs in distributed processing circumstances, under multi owner / proprietor settings. For keeping an eye on the key administration challenges, we isolate the clients into two kinds of areas, to be specific open spaces(public domains) and individual spaces(personal domains). Specifically, the larger part proficient clients are overseen distributive by characteristic experts, while every proprietor just needs to deal with the keys of few clients in her own space. In the open area, Multi - Expert ABE (MA-ABE) to improve the security and to stay away from key escrow issue is used. Every single property specialist (AA) oversees a disjoint subset of client job characteristics, while none of only them can control the security of the general framework. We proposed the components for both key appropriation and encryption so that EHR proprietors can indicate customized fine-grained job-based access arrangements amid encryption of document. In the individual domain, owners / proprietor are directly assigned with the authorization for individual users and encrypt an EHR file under its data attributes.
clinical medicine but of science in general, models the iterative problem solving process as: observations ® opi- nions/assessment ® instructions ® actions. This is actu- ally a synthesis model of Weed’s problem-oriented method and roughly, one can map these from the block of three components shown in Figure 1: “symptom“ becomes “ observation “ , “ diagnosis “ becomes “ opinion or assessment “ , and “ process “ becomes “ instruction “ and “ action “ . The opinions/assessment part is where human hypothesis making or opinion forming bridges the incoming observations and outgoing instructions. It is also where the computer systems can support human decisions, integrating either evidence-based or guideline- based knowledge into the human personal knowledge base. From an opinion/assessment, further advice on prescribing instructions or dispensing actions can be suggested. In the entire process we mentioned above, the openEHR supports the modeling of information structures, by introducing equivalent kinds of archetypes: openEHR-EHR-OBSERVATION, openEHR- EHR-EVALUATION, openEHR-EHR-INSTRUCTION, openEHR-EHR-ACTION. Together with an “ ADMI- N_ENTRY “ , they form the five concrete subtypes of the “ ENTRY “ class (being a collection of “ Data Value “ and collectively forming “ Composition “ ). All clinical informa- tion can ultimately be expressed in “ Entries ” , or logical clinical statements. They are the most important in
been embraced by people and governments with various levels of success (e.g., , , ). In the U.K., there has been a slow uptake of such technologies despite the efforts of the health sector to convert all medical records from paper to electronic format. However, the first attempt to test such technologies in the British public was successfully trialed in the U.K., between 1989 and 1992 . During this trial, over 13 000 patients were provided with smart cards containing health information that only they and health professionals treating them were able to access. The results showed that the majority of participants were in favor of having the cards. However, their use was not continued, as the technology was not sufficiently mature at this time.
(i) Service users. Eight service users were recruited through a local register from various mental health services within SLaM. A service user researcher visited service users in their own homes and showed them the features of myhealthlocker. They were asked a series of structured questions about the attractiveness of the site, appropriateness of text, ease of navigation, usefulness of the ePHR, whether it was culturally relevant, and whether it was user friendly. Service users were asked to rate each domain on a scale of 1-5, to give an indication of any areas that were lacking. Service users were also asked for their comments, which were recorded. In total, each session lasted 1-2 hours. Service users were paid £15 for their time.
As part of the IPHCS project in the Republic of Croatia in 2002, the solution for the central infor- mation system was entrusted to the Ericsson Nikola Tesla company, while contracts to provide appli- cations for the PHC oﬃces were awarded to ﬁve additional companies (ABA Informatics, AME Con- sortium, IPT, IN2, and MCS Group). 13 All data entered in an electronic form are coded and ﬁled into the central information system via the internet; therefore, these data are protected from theft and the conse- quences of local device failure. In order to be able to access the software, each healthcare professional has a Smart Card protected by a personal identiﬁcation number (PIN), which allows him/her to prove his/her identity, code the data, and put an electronic signature on medical records. 19 An additional method of pro- tecting the conﬁdentiality of the data entrusted to the system is an access authorisation issued for each user; each of the users is assigned strictly-deﬁned privileges to access speciﬁc parts of the electronic data entry system. 19
Additionally, health care professionals have used the concept of personalhealth records (PHRs) to preserve patient data. PHRs refer to “an electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment” (, p. 122). PHRs gather health data entered by individuals and can provide in- dividuals ’ health information to healthcare profes- sionals under authorizations by those individuals . Further, PHRs can also capture data from EMRs to share over many hospitals, since patients could re- ceive care from different hospitals . Thus, our study adopts the term EMRs, since we focus on the electronic medical record in one hospital where most of the information is medical data gathered at that hospital, rather than data related to wellness and data gathered across institutions.
An emerging recovery-oriented practice is person-cen- tered care planning, which uses the service planning process to develop and implement an action plan to as- sist the person in achieving his or her unique, personal life goals [13, 14]. Providers complete a service plan with clients on entry into a program and then update the plan every 3 to 6 months. This plan addresses the specific mental health and/or substance use barriers interfering with the person ’ s goal achievement using both profes- sional services and natural supports. Throughout the care planning process, providers elicit and empathize with their clients ’ subjective experiences, regard clients holistically as people rather than as patients, and help people to articu- late their personal recovery goals. Providers then reflect this process in the service plan wherever possible using the service user ’ s own words. Skills include reframing symptoms and impairments as barriers to goal attainment; reframing the use of medications as tools for overcoming these barriers and moving ahead in one ’ s life; instilling hope and identifying short-term, realistic, and measurable objectives. Overall, this approach is framed by a perspec- tive that focuses on the application of clients ’ strengths rather than the treatment of their deficits .
All patients who were enrolled in the bariatric surgery program in the Center for Nutrition and Weight Man- agement at Geisinger Clinic were offered participation in an ongoing research program in obesity using clinical data accessed through the electronichealthrecord that was approved by the Geisinger Clinic Institutional Re- view Board. For this study, a total of 2028 patients who underwent RYGB gastric bypass surgery from 01/01/ 2004 through 07/02/2010 were included in the database. The bariatric surgery program consisted of a 6 to 12 month pre-operative assessment and preparation period that included a diet-induced weight loss target of 10% of body weight. Patients were followed at approxi- mately 1, 3, 5, and 12 months following RYGB surgery and every 12 months thereafter. All clinical data were entered into the EpicCare W EHR (Verona, WI). The EpicCare W EHR integrates information from a variety of sources into a common interoperable database that includes patient demographics, vitals, clinical measures, problem list (based on ICD-9 codes), medical history, medication history, personal and family histories, encounters (e.g. office visits, hospitalizations, nurse encounters, telephone inquiries and specialty consulta- tions), orders (e.g. labs, medications, imaging and proce- dures), appointments, digital imaging (e.g. MRI, CT, X- ray, medical photography), results (e.g. procedure reports, lab results, pathology reports), and billing and claims databases (detailed financial transactions asso- ciated with each clinical encounter). All data except
established. The aim of this project is to design, implement and evaluate a prototype patient held electronichealthrecord card. One of the tasks involved in the project was to develop a Graphical User Interface (GUI) software, which provides access to the data stored on the card. The requirements for this software had to be established via questionnaire surveys and end user evaluations, conducted simultaneously with the software development. This paper is addressing development of the MyCare Card GUI software. It also overviews the hardware and open-source software solutions selected for the MyCare Card implementation.
E-Health is described as a revolutionary new paradigm for health care that has evolved as a result of advances in information, telecommunication, network technologies and information management. These technologies have transformed the way that health care is delivered [1,2]. Today's technology has the capability to support people in managing almost all aspects of their health care, from seeking general health information to clinical consults without ever having to leave their homes; yet even the most basic personalhealth information, like specific results of tests, contained in medical charts is not currently readily available through existing technologies (like the Internet) to most consumers of health care [3,4]. This inaccessibility makes it difficult for consumers of health care to be active participants in their own health and well- ness. There is consensus that in order for patients to be true partners in the health care encounter, they must have access to their own personal clinical health information (Wiljer et al., Patient Accessible EHRs: Building consensus for successful implementation strategies, submitted) that is commonly stored in institutional electronichealth records (EHRs). An ElectronicHealthRecord (EHR) is a computerized version of an individual's healthrecord that may contain a person's full health and medical record or can be used for certain records, such as lab results, in con- junction with a more traditional paper-based patient chart. The EHR may be accessible online from many sep- arate, interoperable automated systems within an elec- tronic network and it can facilitate the electronic integration of health care providers by enabling the retrieval of information about patients when and where it is most needed . The ability to provide patients with access to their personalhealth information can be facili- tated through the use of emerging technologies, most commonly through the Internet [6-9]. This type of access to one's own health information can help prepare individ- uals to better manage and cope with their health status. In turn, this type of access may have a positive impact on the health care system that can be recognized through more efficient use of resources resulting in health care savings . Access to personalhealth information is a fundamen- tal right supported by the law  and the emergence of new technologies alters how that right can be fulfilled. It has been demonstrated that access to one's health infor- mation using these technologies is desired by many health care consumers [7,11-15].
were identified as unnecessary elements by the majority of participants in the study (26) . In this study, as in the present study, a survey was conducted to determine the minimum data set. The Elements of father's name, national code, patient's address were selected as the main data elements. In Abdolkhani study (14) entitled as "Comparative study of minimum data set of athletes' health records in selected countries and presenting a model for Iran" in 2014, the researcher's questionnaire was designed based on the different sites of Sports Medicine of America, Australia, Canada as well as the Olympics website, and domestic activities by referring to Federation of Sports Medicine of Islamic Republic of Iran and examining the clinical examination forms used by the Federation and study the standard forms for reporting injuries, health history, physical examinations and clinical forms of the mentioned three countries and examples of electronicpersonalhealth records. The questionnaire included 11 sections of demographic information, health history, general body examinations, reporting injuries, physical examinations, medication, surgeries, physical therapy, nutrition, dental care and vaccination. The questionnaire was provided to 50 available samples of specialists of sports medicine, sport injuries and corrective actions, health information management, medical informatics and medical records. The demographic information included name and surname, father's name, place of birth, marital status, national code, registration number, date of birth, sex, blood group, address and phone number, name of the federation and information elements, sports team name and the name of the club. In the section of information elements of the health history, the factors of drug allergies, taking medications, past medical history, surgical history and family history of certain diseases were identified as information elements of Electronicpersonalhealthrecord of athletes. In the section of general body examinations, the factors of cause for referring, history of current illness and recording cardiopulmonary, musculoskeletal, neurological,
dren are provided vaccine at no charge, requires provid- ers to maintain a separate stock of vaccine, to assess eligibility for the program, and to submit reports to the program. All of these activities require support from the information system used to track immunization data. The NCVIA has numerous implications for immuniza- tion data recording. Among these is the requirement to deliver to the parent (or equivalent health decision- maker) a vaccine information statement (VIS) and to record when it was given and which version of the VIS was given. The NCVIA also mandates that health care providers report adverse events associated with vaccines; although this applies equally to adult providers, automa- tion of this reporting capability would be of particular interest to child health care providers, who give the bulk of vaccines. The Centers for Disease Control and Preven- tion’s National Immunization Program (www.cdc.gov/ nip) specifies these information-management require- ments in detail. EHR systems also need to manage the record of consent for vaccine administration. Vaccine refusal 8 by a parent or patient requires the recording of
Infoway is a not-for-profit organisation set up to foster and accelerate the development, and the adoption of electronichealth information systems. Infoway has utilised existing information systems, driving for compatible standards and communications technologies to be adopted nationwide. Infoway has strategically directed the implementation of the EHR in Canada in collaboration with provinces and territories. The organisation is governed by Canada’s 14 federal, provincial and territorial Deputy Ministers of Health. (Infoway 2013; 2015).