Display omitted
•Design and implementation of a tethered PHR using HL7 Fast Healthcare Interoperability Resources (FHIR)•Implementation leverages FHIR healthcare data as service and API ...approach.•Advantages of using HL7 FHIR compared to previous efforts that relied on document-centric standards.•Ability to customize the PHR using FHIR resources and profiles.
The rapid growth and acceptance of Electronic Health Records (EHRs) and standards to exchange EHRs have improved various aspects of health practices and patient care. However, the data captured in an EHR is only accessible to the providers and specialists within an organization, but not the patient. The concept of a Personal Health Record (PHR) is to allow the patients to record and manage their health data beyond EHR and if possible, see the EHR data in the PHR. Experts agree that bi-directional communication between the PHR and EHR allows the PHR to be more effective and a valuable tool for both the providers and patients. Communicating near real-time patient recorded data in PHR with an EHR will allow the provider(s) to make appropriate clinical decisions and patients can see any changes to his/her diagnostics or treatment plans. This research explores and critically analyzes HL7 FHIR to design and prototype an interoperable mobile PHR that conforms to the HL7 PHR Functional Model and allows bi-directional communication with OpenEMR.
•There are many health literacy demands of ePHRs which affect user groups.•The attitudes and beliefs of patients and providers impact on the use of e- PHRs.•Most research on e-PHRs has focused on ...patients with chronic health conditions.•Implementation research that is inclusive of diverse patient groups is needed.
To integrate the findings of research on electronic personal health records (e-PHRs) for an understanding of their health literacy demands on both patients and providers.
We sought peer-reviewed primary research in English addressing the health literacy demands of e-PHRs that are online and allow patients any degree of control or input to the record. A synthesis of three theoretical models was used to frame the analysis of 24 studies.
e-PHRs pose a wide range of health literacy demands on both patients and health service providers. Patient participation in e-PHRs relies not only on their level of education and computer literacy, and attitudes to sharing health information, but also upon their executive function, verbal expression, and understanding of spoken and written language.
The multiple health literacy demands of e-PHRs must be considered when implementing population-wide initiatives for storing and sharing health information using these systems.
The health literacy demands of e-PHRs are high and could potentially exclude many patients unless strategies are adopted to support their use of these systems. Developing strategies for all patients to meet or reduce the high health literacy demands of e-PHRs will be important in population-wide implementation.
Display omitted
•Implementation of a PHR that integrates distributed health records using blockchain.•Method involves implementing a prototype from different production databases.•Data set of more ...than 40,000 adult patients anonymized from two hospitals.•Results indicated data distributed via a blockchain recovered with low latency.•OmniPHR model can integrate distributed data into a unified view of health records.
The Personal Health Record (PHR) and Electronic Health Record (EHR) play a key role in more efficient access to health records by health professionals and patients. It is hard, however, to obtain a unified view of health data that is distributed across different health providers. In particular, health records are commonly scattered in multiple places and are not integrated.
This article presents the implementation and evaluation of a PHR model that integrates distributed health records using blockchain technology and the openEHR interoperability standard. We thus follow OmniPHR architecture model, which describes an infrastructure that supports the implementation of a distributed and interoperable PHR.
Our method involves implementing a prototype and then evaluating the integration and performance of medical records from different production databases. In addition to evaluating the unified view of records, our evaluation criteria also focused on non-functional performance requirements, such as response time, CPU usage, memory occupation, disk, and network usage.
We evaluated our model implementation using the data set of more than 40 thousand adult patients anonymized from two hospital databases. We tested the distribution and reintegration of the data to compose a single view of health records. Moreover, we profiled the model by evaluating a scenario with 10 superpeers and thousands of competing sessions transacting operations on health records simultaneously, resulting in an average response time below 500 ms. The blockchain implemented in our prototype achieved 98% availability.
Our performance results indicated that data distributed via a blockchain could be recovered with low average response time and high availability in the scenarios we tested. Our study also demonstrated how OmniPHR model implementation can integrate distributed data into a unified view of health records.
The sharing of Personal Health Records (PHR) in cloud computing is a promising platform of health information exchange. However, the storage of personal medical and health information is usually ...outsourced to some third parties which may result in the exposure of patients’ privacy to unauthorized individuals or organizations. In order to address this security loophole, we suggest a promising solution. We propose a new approach for fine-grained access control and secure sharing of signcrypted (sign-then-encrypt) data. We call our new primitive Ciphertext-Policy Attribute-Based Signcryption (CP-ABSC) which satisfies the requirements of cloud computing scenarios for PHR. CP-ABSC combines the merits of digital signature and encryption to provide confidentiality, authenticity, unforgeability, anonymity and collusion resistance. The correctness, security and efficiency of this scheme are also proven.
•We propose a new approach for fine-grained access control and secure sharing of signcrypted data.•Our new primitive Ciphertext-Policy Attribute Based Signcryption (CP-ABSC) satisfies the requirements of cloud computing scenarios for PHR.•CP-ABSC provides confidentiality, authenticity, unforgeability, anonymity and collusion resistance.
is a Gram-positive spore-forming bacterium pathogenic to various insect species. This property is due to the Cry toxins encoded by plasmid genes and mostly produced during sporulation.
contains a ...remarkable number of extrachromosomal DNA molecules and a great number of plasmid
genes. Rap-Phr quorum-sensing systems regulate different bacterial processes, notably the commitment to sporulation in
species. Rap proteins are quorum sensors acting as phosphatases on Spo0F, an intermediate of the sporulation phosphorelay, and are inhibited by Phr peptides that function as signaling molecules. In this study, we characterize the Rap63-Phr63 system encoded by the pAW63 plasmid from the
serovar kurstaki HD73 strain. Rap63 has moderate activity on sporulation and is inhibited by the Phr63 peptide. The
genes are cotranscribed, and the
gene is also transcribed from a σ
-specific promoter. We show that Rap63-Phr63 regulates sporulation together with the Rap8-Phr8 system harbored by plasmid pHT8_1 of the HD73 strain. Interestingly, the deletion of both
and
genes in the same strain has a greater negative effect on sporulation than the sum of the loss of each
gene. Despite the similarities in the Phr8 and Phr63 sequences, there is no cross talk between the two systems. Our results suggest a synergism of these two Rap-Phr systems in the regulation of the sporulation of
at the end of the infectious cycle in insects, thus pointing out the roles of the plasmids in the fitness of the bacterium.
The life cycle of
in insect larvae is regulated by quorum-sensing systems of the RNPP family. After the toxemia caused by Cry insecticidal toxins, the sequential activation of these systems allows the bacterium to trigger first a state of virulence (regulated by PlcR-PapR) and then a necrotrophic lifestyle (regulated by NprR-NprX); ultimately, sporulation is controlled by the Rap-Phr systems. Our study describes a new
operon carried by a
plasmid and shows that the Rap protein has a moderate effect on sporulation. However, this system, in combination with another plasmidic
operon, provides effective control of sporulation when the bacteria develop in the cadavers of infected insect larvae. Overall, this study highlights the important adaptive role of the plasmid Rap-Phr systems in the developmental fate of
and its survival within its ecological niche.
Cyclobutane pyrimidine dimers (CPD), as a common DNA damage caused by UV radiation, often lead to skin cancer. Here, we identified a photolyase from the alga Arthrospira platensis (designated as ...Ap‐phr), which has been regarded as a safe organism for humans for centuries, that can efficiently repair CPD lesions in ssDNA and dsDNA in vitro. The 1.6 Å resolution crystal structure of Ap‐phr revealed that it possesses a unique methenyltetrahydrofolate chromophore‐binding pattern with high energy transfer efficiency. Our study of Ap‐phr highlights its potential use in cosmetic, industrial and aesthetic medicine applications.
Display omitted
•We propose OmniPHR, a P22/Blockchain based architecture for Personal Health Records.•The proposal allows a unified view, integrating patients’ scattered health records.•OmniPHR ...promotes interoperability among different providers to access health record.•The evaluation showed the feasibility of OmniPHR in terms of elasticity/scalability.•The scientific contribution is a proposal of a distributed and interoperable PHR.
The advances in the Information and Communications Technology (ICT) brought many benefits to the healthcare area, specially to digital storage of patients’ health records. However, it is still a challenge to have a unified viewpoint of patients’ health history, because typically health data is scattered among different health organizations. Furthermore, there are several standards for these records, some of them open and others proprietary. Usually health records are stored in databases within health organizations and rarely have external access. This situation applies mainly to cases where patients’ data are maintained by healthcare providers, known as EHRs (Electronic Health Records). In case of PHRs (Personal Health Records), in which patients by definition can manage their health records, they usually have no control over their data stored in healthcare providers’ databases. Thereby, we envision two main challenges regarding PHR context: first, how patients could have a unified view of their scattered health records, and second, how healthcare providers can access up-to-date data regarding their patients, even though changes occurred elsewhere. For addressing these issues, this work proposes a model named OmniPHR, a distributed model to integrate PHRs, for patients and healthcare providers use. The scientific contribution is to propose an architecture model to support a distributed PHR, where patients can maintain their health history in an unified viewpoint, from any device anywhere. Likewise, for healthcare providers, the possibility of having their patients data interconnected among health organizations. The evaluation demonstrates the feasibility of the model in maintaining health records distributed in an architecture model that promotes a unified view of PHR with elasticity and scalability of the solution.
Heterogeneity is a problem in storing and exchanging data in a digital health information system (HIS) following semantic and structural integrity. The existing literature shows different methods to ...overcome this problem. Fast healthcare interoperable resources (FHIR) as a structural standard may explain other information models, (e.g., personal, physiological, and behavioral data from heterogeneous sources, such as activity sensors, questionnaires, and interviews) with semantic vocabularies, (e.g., Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT)) to connect personal health data to an electronic health record (EHR). We design and develop an intuitive health coaching (eCoach) smartphone application to prove the concept. We combine HL7 FHIR and SNOMED-CT vocabularies to exchange personal health data in JavaScript object notion (JSON). This study explores and analyzes our attempt to design and implement a structurally and logically compatible tethered personal health record (PHR) that allows bidirectional communication with an EHR. Our eCoach prototype implements most PHR-S FM functions as an interoperability quality standard. Its end-to-end (E2E) data are protected with a TSD (Services for Sensitive Data) security mechanism. We achieve 0% data loss and 0% unreliable performances during data transfer between PHR and EHR. Furthermore, this experimental study shows the effectiveness of FHIR modular resources toward flexible management of data components in the PHR (eCoach) prototype.
Information seeking is becoming an indispensable activity in daily life, especially in the medical cloud. Body Area Network (BAN) is becoming more and more popular with respect to the development and ...popularity of mobile devices. People are starting to back up the medical data to cloud, make data accessible by the doctors from almost anywhere using mobile terminals. In this paper, we present an efficient and secure fine-grained access control scheme which not only achieves authorized users to access the records in cloud storage, but also supports a small set of physicians to write on the records. In order to improve the efficiency, we put forward a novel technique called match-then-decrypt, which is used to perform the decryption test without decryption. Also, the scheme outsources bilinear pairing operations to a gateway without revealing the data content, and thus largely eliminates this overhead for users to a great extent. The performance assessments demonstrate the efficiency of our proposed solution in terms of computation, communication, and storage.
PDF
