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Communication and information technologies have accelerated the implementation of electronic medical records, but at the same time, have put patient privacy, information security and health data at risk. An alternative to address the problem of security and privacy of medical data is the use of blockchain. Scalability has become one of the biggest challenges facing the development of blockchain-based electronic health records (EHRs). The purpose of this article is to implement and test a scalable blockchain-based EHR management system. For this reason, we present a scalable blockchain-based EHR management architecture. In this paper, we propose an EHR management model based on entities and user roles, adapt, and then implement with Hyperledger Fabric in a two-channel configuration. We develop a prototype in Fabric using a one-and two-channel configuration. We then designed and conducted an experiment to verify the performance of the proposed scheme in terms of scalability improvement. This scalable blockchain-based EHR management solution, such as the Hyperledger Fabric platform, offers a viable alternative to address scalability issues, as well as to protect patient’s privacy and the security of their medical data.

This study aimed to validate trial patient eligibility screening and baseline data collection using text-mining in electronic healthcare records (EHRs), comparing the results to those of an international trial. In three medical centers with different EHR vendors, EHR-based text-mining was used to automatically screen patients for trial eligibility and extract baseline data on nineteen characteristics. First, the yield of screening with automated EHR text-mining search was compared with manual screening by research personnel. Second, the accuracy of extracted baseline data by EHR text mining was compared to manual data entry by research personnel. Of the 92,466 patients visiting the out-patient cardiology departments, 568 (0.6%) were enrolled in the trial during its recruitment period using manual screening methods. Automated EHR data screening of all patients showed that the number of patients needed to screen could be reduced by 73,863 (79.9%). The remaining 18,603 (20.1%) contained 458 of the actual participants (82.4% of participants). In trial participants, automated EHR text-mining missed a median of 2.8% (Interquartile range [IQR] across all variables 0.4–8.5%) of all data points compared to manually collected data. The overall accuracy of automatically extracted data was 88.0% (IQR 84.7–92.8%). Automatically extracting data from EHRs using text-mining can be used to identify trial participants and to collect baseline information.

As a result of the proliferation of digital and network technologies in all facets of modern society, including the healthcare systems, the widespread adoption of Electronic Healthcare Records (EHRs) has become the norm. At the same time, Blockchain has been widely accepted as a potent solution for addressing security issues in any untrusted, distributed, decentralized application and has thus seen a slew of works on Blockchain-enabled EHRs. However, most such prototypes ignore the performance aspects of proposed designs. In this paper, a prototype for a Blockchain-based EHR has been presented that employs smart contracts with Hyperledger Fabric 2.0, which also provides a unified performance analysis with Hyperledger Caliper 0.4.2. The additional contribution of this paper lies in the use of a multi-hosted testbed for the performance analysis in addition to far more realistic Gossip-based traffic scenario analysis with Tcpdump tools. Moreover, the prototype is tested for performance with superior transaction ordering schemes such as Kafka and RAFT, unlike other literature that mostly uses SOLO for the purpose, which accounts for superior fault tolerance. All of these additional unique features make the performance evaluation presented herein much more realistic and hence adds hugely to the credibility of the results obtained. The proposed framework within the multi-host instances continues to behave more successfully with high throughput, low latency, and low utilization of resources for opening, querying, and transferring transactions into a healthcare Blockchain network. The results obtained in various rounds of evaluation demonstrate the superiority of the proposed framework.

Current trend in health-care industry is to shift its data on the cloud, to increase availability of Electronic Health Records (EHR) e.g. Patient’s medical history in real time, which will allow sharing of EHR with ease. However, this conventional cloud-based data sharing environment has data security and privacy issues. This paper proposes a distributed solution based on blockchain technology for trusted Health Information Exchange (HIE). In addition to exchange of EHR between patient and doctor, the proposed system is also used in other aspects of healthcare such as improving the insurance claim and making data available for research organizations. Medical data is very sensitive, in both social as well as legal aspects, so permissioned block-chain such as Hyperledger Fabric is used to retain the necessary privacy required in the proposed system. As, this is highly permissioned network where the owner of the network i.e. patient holds all the access rights, so in case of emergency situations the proposed system has a Backup Access System which will allow healthcare professionals to access partial EHR and this backup access is provided by using wearable IOT device.

The electronic representation of a patient's medical information is called an electronic health record, or EHR. Normally, these records are kept on cloud-based or central servers. Blockchain technology is a new technology used to solve security and privacy problems of EHR data in a decentralized way. Hence, they are accessible to authorized health providers for better management of patient care. Building secure e-health systems with public blockchains such as Ethereum faces several problems. The main issue is that these blockchains are permissionless; everybody can join in and obtain access to the data, which becomes a cause of significant privacy concerns. This research proposes a private and decentralized e-healthcare system using Hyperledger Fabric and the Interplanetary File System (IPFS) for securely and effectively storing and retrieving EHRs. Privacy and security are guaranteed with Hyperledger Fabric in ensuring that only authorized parties can access sensitive medical information. The system is further enhanced to include decentralized storage based on IPFS for the storage of medical images and files that cannot be directly stored in the blockchain.

Industry predictions focus on future e-hospitals that will integrate all stakeholders into a seamless network, allowing data to be shared. The Health Level Seven (HL7) is a standard for the interchange of data within the healthcare industry. It simplifies communication interfaces and allows the interoperability among heterogeneous applications. Although the benefits of adopting HL7 are well known, only a few hospitals in Taiwan have actually adopted it. What are the reasons behind the hospitals’ lack of intention to adopt HL7? Most prior studies on HL7 have focused on technical issues and general overlooked the managerial side. This has caused a lack of understanding of factors influencing hospitals’ decision on HL7 adoption. In fact, main reasons behind a hospital’s decision on whether to adopt an innovative technology are more often related to organizational than purely technical issues. Hence, we pay our attention to these organizational considerations over HL7 adoption. Based on the Innovation Diffusion Theory, we proposed a research model to explore the critical factors influencing Taiwan hospitals’ adoption intention of HL7. 472 questionnaires were distributed to all accredited hospitals in Taiwan and 122 were returned. The valid response rate was 25.21% (119). Factor analysis, logistic regression and Pearson Chi-square test were conducted to verify the research model. The results showed that environmental pressure, top management attitude towards HL7, staff’s technology capability, system integrity, and hospital’s scale were critical factors influencing hospitals’ intention on whether to adopt HL7. The research findings provided the government, the healthcare industry, the hospital administrators and the academia with practical and theoretical references. These factors should be considered in planning promotion plan to encourage hospital adoption of HL7. This study also opens up a new research direction as well as a new viewpoint, and consequentially improves the completeness of related researches in the medical informatics discipline.

Safety‐related warnings and market withdrawal of prominent drugs in recent years have fueled efforts to consider other data sources for surveillance and to develop new methodologies in order to supplement existing pharmacovigilance systems. One of the important resources posited to have enormous potential for proactive safety surveillance are electronic healthcare records (EHRs). Linking of healthcare databases for active drug safety surveillance is feasible in Europe, and yet the leverage to do so may be too low for very rare events and for drugs that are infrequently used, or captured, in the databases, and a system such as exploring and understanding adverse drug reactions (EU‐ADR) may be better at detecting signals with lower strength of association for events that have a relatively high background frequency.

The healthcare industry has been transitioning from paper-based medical records to electronic health records (EHRs) in most healthcare facilities. However, the current EHR frameworks face challenges in secure data storage, credibility, and management. Interoperability and user control of personal data are also significant concerns in the healthcare sector. Although block chain technology has emerged as a powerful solution that can offer the properties of immutability, security, and user control on stored records, its potential application in EHR frameworks is not yet fully understood. To address this gap in knowledge, this research aims to provide an interoperable blockchain-based EHR framework that can fulfill the requirements defined by various national and international EHR standards such as HIPAA and HL7. The research method employed is a systematic literature review to explore the current state of the art in the field of EHRs, including blockchain-based implementations of EHRs. The study defines the interoperability issues in the existing blockchain-based EHR frameworks, reviews various national and international standards of EHR, and further defines the interoperability requirements based on these standards. The proposed framework can offer safer methods to interchange health information for the healthcare sector and can provide the properties of immutability, security, and user control on stored records without the need for centralized storage. The contributions of this work include enhancing the understanding of the potential application of blockchain technology in EHR frameworks and proposing an interoperable blockchain-based EHR framework that can fulfill the requirements defined by various national and international EHR standards. Overall, this study has significant implications for the healthcare sector, as it can enhance the secure sharing and storage of electronic health data while ensuring the confidentiality, privacy, and integrity of medical records.

Purpose: There have been mixed findings of clinicians’ perceptions of Electronic Health Record (EHR). This study aims to explore the lived experiences of clinicians, to assess the role of EHR in improving the quality and safety of healthcare. Basic Procedures: A qualitative study design was used. We collected the opinions from different groups of clinicians (physicians, hospitalists, nurse practitioners, nurses, and patient safety officers) using semi-structured interviews. Organizations represented were trauma hospitals, academic medical centers, medical clinics, home health centers, and small hospitals. Main findings: Our study found clinicians’ ambivalent assessments toward EHR, which confirms extant literature. We compared the responses by job roles and found that nurses were positive about improving efficiency with EHR while others regarded EHR as time-consuming. While many underscored the importance of EHR in avoiding medical errors by improving data accessibility, nurses had concerns regarding data accuracy. Interoperability appeared to be a concern given limited system integration. Principal conclusions: Lived experiences of clinicians further tease out the mixed views about the effectiveness of EHR and highlight the challenges in EHR implementation. Redesigning the EHR and improving its implementation process may be potential solutions to increase its effectiveness.

Background The adoption of an electronic health record (EHR) in the healthcare system has the potential to make healthcare service delivery effective and efficient by providing accurate, up-to-date, and complete information. Despite its great importance, the adoptions of EHR in low-income country settings, like Ethiopia, were lagging and increasingly failed. Assessing the readiness of stakeholders before the actual adoption of EHR is considered the prominent solution to tackle the problem. However, little is known about healthcare providers’ EHR readiness in this study setting. Accordingly, this research was conducted aiming at examining healthcare providers’ readiness for EHR adoption and associated factors in southwestern Ethiopia. Methods An institutional-based cross-sectional study was conducted from September 1 to October 30, 2021. A total of 423 healthcare providers working in public hospitals were selected using a simple random sampling technique. Multivariable logistic regression was fitted to identify determinant factors of overall healthcare providers’ readiness after the other covariates were controlled. Result In this study, the overall good readiness level of EHR adoption was 52.8% ( n  = 204) [95% CI of 47.9% to 56.6%]. Age, computer literacy, computer access at health facilities, attitude towards EHRs, awareness about EHRs, perceived benefit, and perceived technology self-efficacy were significantly associated with the overall health care providers’ readiness for the adoption of EHR using a cut point of P -value less than 0.05. Conclusion Around half of the respondents had a good level of overall healthcare providers’ readiness for the adoption of EHR which was considered inadequate. This finding implied that a huge effort is required to improve readiness before the actual implementation of EHRs. The finding implied that younger-aged groups were more ready for such technology which in turn implied; the older one needs more concern. Enhancing computer literacy, confidence building to raise self-efficacy of such technology, addressing the issue of computer availability at health facilities, building a positive attitude, awareness campaign of EHR, and recognizing the usefulness of such systems were the necessary measures to improve EHR readiness in this setting. Additionally, further studies are recommended to encompass all types of EHR readiness such as organizational readiness, technology readiness, societal readiness, and so on. Additionally, exploring the healthcare provider opinion with qualitative study and extending the proposed study to other implementation settings are recommended to be addressed by future works.