Electronic Health Records (EHR): A Comprehensive Analysis of Implementation and Integration

This assignment explores the transformative potential of Electronic Health Records (EHR) in the healthcare industry. It delves into the architecture, implementation, and integration challenges of EHR systems, highlighting the benefits and challenges associated with their adoption. The paper examines the role of information management and integration in leveraging the vast amounts of structured and unstructured data generated by EHR systems. It also discusses the importance of data privacy and security in ensuring patient confidentiality and trust. The assignment concludes with recommendations for optimizing EHR implementation and integration, emphasizing the role of cloud computing, text-based analytical tools, and standardized data structures.

Data and system integration
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ICT705 Data and System Integration - Assignment 1
Executive Summary
Electronic Health Records (EHR), a major breakthrough in the medical industry and is going
to transform the Health Care Industry.
Deployment of EHR was to reduce limitations of Medical Care, Cost, and Integrity &
Availability of Patient Medical Information.
Electronic Health Records is an evitable due to Internal and External factors, wherein the
Patient Information, Cost and better Medical Care, Medical Insurance has been the most
important part of adopting EHR.
Information Systems has played a major role and bridged the gap in adopting Electronic
Health Records across the world.
Medical Insurance has seen a lot of growth in terms of Demand. Due to the increasing
demand in Healthcare Industry, it has a huge potential to grow, however, it is a risk as well
due to the incremental costs, Inconsistent quality of Medical Care, In-Efficient Coordinated
Systems.
Hence, it became very important to support and enhance Health Care Industry via Electronic
Health Records, which can improve Efficiency, Cost, Safety and Quality of Medical Care.
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ICT705 Data and System Integration - Assignment 1
Table of Contents
Executive Summary...................................................................................................................ii
Introduction................................................................................................................................1
Enterprise Information Architecture..........................................................................................2
EHR Implementation View........................................................................................................7
Various Domains where EHR has been Useful.........................................................................9
Information Management and Integration...............................................................................11
Conclusion................................................................................................................................13
Recommendations....................................................................................................................14
Bibliography.............................................................................................................................15
References................................................................................................................................16
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ICT705 Data and System Integration - Assignment 1
Introduction
In this Information age, Internet has bridged the gap between an Information System and the
Health Care centers. Traditionally, Capturing and Recording of Patient Information were
paper-based.
This gave a rose to issues within the System like,
High Probability of errors and duplicity while capturing Information about Patients,
Sorting of medical records became difficult as and when the number of Patients increased,
Information Leakage of critical and sensitive Patient Data, Strong Probability of Damage to
Patient Information due to natural or human-made errors, Increases workload and bigger
space to keep Patient records and in turn, requires bigger staff for the documents safety and
integrity.
To provide Safety, Consistency and Coordinated care at a reasonable cost, Health Care
Industry has adopted Electronic Health Records. EHR has evolved as a systematic collection
of electronic health information of a Patient. As recorded digitally, it is easy to include a
range of information like lab results, images, medical history, and demographics besides
statistical data of a patient like date of birth, age, gender, etc.
It leads to many advantages like,
Improved Clinical Documentation and Customer Service, more efficient Clinical Workflows,
reduced Transcription Costs, Improved Medication Management, Improved Medical Care,
Better Management of Patient Records, access to Patient records became easy including
fetching long history of Patients, Faster care and Decision-Making Process, restriction on
forging of Medical Records and Prescriptions, in turn, consuming restricted drugs.
It also made better Data Privacy and Security of Patient Records including Medical
Prescriptions, Treatments, and Financial Records, Reduction in stealing Identity of Patients,
Improved Intra and Inter-Hospital Communications, Reduction in overhead and growth in
practice, Increase in revenues, better management of Managed Care Contracting.
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ICT705 Data and System Integration - Assignment 1
Enterprise Information Architecture
ISO 15704 states, Enterprise Architecture as an arrangement between the components and the
flow of data or the connectivity between the parts of the components.UK and USA are the
best examples of implementing nationwide EHR.
Gartner defines EIA (Enterprise Information Architecture) as a part of the Enterprise
Architectural process that describes-through a set of requirements, principles, and models-
the current state, future state and the guidance necessary for flexible information sharing to
achieve an effective Information sharing model(Sajid and Ahsan, 2014).
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ICT705 Data and System Integration - Assignment 1
Proposed Architecture of the EHR: Below proposed Cloud or SaaS-based EHR [9] has
multiple benefits.
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Connected via 3G/4G/WiFi/Intranet Connected via 3G/4G/WiFi/Intranet
Connected via 3G/4G/WiFi/Intranet Connected via 3G/4G/WiFi/Intranet
Central Database
Network
Interface
Middlew
are
Authentication
Server

ICT705 Data and System Integration - Assignment 1
In the above Cloud or SaaS (software as a Service) based Architecture, with 2 major
components- named, Cloud-Based System connected via 3G/4G/WiFi or Intranet and Health
Care Web Portal.
Cloud-Based System consists of a Central Database Server, a Network Interface including a
Middleware and an Authentication Server.
Central Database Server acts as a Unified Central Bank for all the Hospitals, Clinics and
Patients across the Nation. It is a Central Data Repository to host Electronic Medical Records
of Patient, Hospitals or clinics across the Country. This is available on Cloud, with proper
Authentication on the Authentication Server via genuine Login Credentials. Patients and
Hospitals can login into the System and collect the requested Information. The
Authentication Server checks for the login credentials against the user trying to get an access
and checks in the Local Database for the same, and accordingly GrantsAccess to the user, if
Authenticated, else the user is Denied Access (Sappagh, and Masri,2014).
Information from the Database is gathered via passing queries to an Interface (a Middleware)
to the Database and as shown on the Web Interface on to the Hospitals.
Middleware is hosted on Cloud to check for Web or Network traffic coming into the Interface
to facilitate the communication transactions between the Central Database and the Hospitals.
This Cloud-based Interface is equipped to handle queries coming in via 3G/4G, WiFi or
Intranet.
Simultaneously, it is equipped to handle multiple transactions at the same time.
Cloud-based Authentication Server handles all the Authentication and Authorization for the
queries. Any Authenticated User as per the Role Based Access Policies (RBAC) can perform
operations like Searching, Updating, Transferring the Patient Records. HIPPA, HL7
Certifications are the golden standards for the Healthcare Industry in the World.
Data Protection Act will be applied to this Cloud-Based System to protect the interest of
Patients and in turn, will maintain Data Privacy and Secure Information for them.
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ICT705 Data and System Integration - Assignment 1
Security and privacy controls or Provisions are applied for safeguarding Medical Information.
The Privacy Act 1988 of the Australian Government, provides these regulations to be
Implemented.
Health Care Web Portal will be the Front End Interface of the EHR, which would be
available to all the Hospitals, Clinics, Medical Research Labs and to the Patients, as a
Software as a Service (SaaS). The web portal will exchange messages between Hospitals and
the Middleware.
The End User (Patient) will have an Authority to share or restrict the level of Information,
that can be shared from the Database. However, the Patient will not be able to delete any
Information randomly on his own. For any changes in the Patient Statistical Records, a proper
Authorization and an Approval will be required and will not be able to change the Historical
Information from the Database, until and unless the entered Information is Incorrect(Cho and
Kim, 2010).
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ICT705 Data and System Integration - Assignment 1
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ICT705 Data and System Integration - Assignment 1
EHR Implementation
EHR Implementation View
As demonstrated in the above EHR Implementation diagram, Users can be anyone from
Doctors to Nurses, Patients to Pharmacist for the system. The Users will be using Devices
like Tablets or Mobile Phones or Rugged Devices or Desktops or Laptops, which is used to
access SaaS or Cloud-based EHR Portal (Pessi, Magoulas and Hugoson, 2011).
Portability is one of the major requirements in this type of system, wherein, Users can access
EHR for different reasons anywhere on the go.
EHR Portal on Cloud will be in synchronization with the Application on the devices or via
the Web Page through the Browser Window. The Applications running EHR App on devices
will be transmitting the Information to the EHR Portal on Cloud. For example, Patients can
see their lab reports on the devices remotely as and when the reports are ready and pushed via
labs to the EHR portal.
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PresentationTier(WebPortal)ApplicationTier(ApplicationServer)MiddleTier(Services)Devices (Tablets/Phones/Rugged
Devices/Desktops/Laptops)
Users (Doctors/Nurses/Pharmacist/Patients)

ICT705 Data and System Integration - Assignment 1
The above EHR implementation view of the Architecture Proposed state, as a Multi-Layered
Architecture, where the first layer, called Presentation Layer, will facilitate communication
via Web Portal with Users connected via Devices.
Web Portal will communicate to Application Server on Application Tier where User provided
Data is processed. Services running on Middle Tier working closely with the Application
Server will help run the Application Server and help in resolving technical issues like the
connection with different protocols, integration issues, requests handling, etc.
These services will directly Interact and perform Operations on the Database at the Backend
like retrieving data, updating data, etc. on the Database contains all sorts of records about the
Patient.
Patients will have an edge to restrict the Information seen by other users; however, Users
cannot delete any Information History about the Patient in any form.
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ICT705 Data and System Integration - Assignment 1
Various Domains where EHR has been Useful
The above diagram shows the Usage in multiple domains of implementing an EHR.
1. It enhances Patient’s care as it became easy to access Patient‘s history by Physicians
on demand and can devote quality time to the Patients.
2. Pharmaceutical companies might get involved in analyzing data from EHR.
3. Insurance Companies might request data to analyze fraud and provide insurance
policies as per the Patient’s History.
4. Public Health Department will analyze data to promote specific actions required as
per the diseases or to prevent citizens of the Country in any form.
5. Research Labs might analyze data to promote Research in a specific area.
6. Radiology or Labs will have access to upload medical reports of the Patient.
7. Ambulatory Care will be necessary if Ambulance is required to the Patient in the time
of Urgency.
8. Hospital will require access to EHR once patients visit the hospital for any
Consultancy, Surgery or for any Medical Issues.
9. Finally, EHR used by Patients to access their History for many reasons.
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EHR
Public Health
Department
Hospital
Pharmacy
Radiology/Labs
PHR (Patient)
Ambulatory Care
Insurance
Company
Research
Primary Care

ICT705 Data and System Integration - Assignment 1
Various Benefits of Proposed System
Benefits achieved by implementing EHR are in the Proposed System:
1. Data Privacy and Security achieved only Authorised Personnel or Users have an
access to the Patient’s Information.
2. Better Clinical Care at a crucial time will get dedicated to the Patient.
3. Better Clinical Documentation achieved as major data will be entered in the specific
form or standard which is understandable not only to different Doctors but will be
easy for Patients as well.
4. Better management of medical records as compared to traditional paper-based
management.
5. Fast Increase in Decision Making Process by the Hospitals/Clinics.
6. Due to Digitization, forgery of medical prescription would be difficult.
7. Reduction in stealing Identity of Patients for multiple reasons.
8. Reduction in overheads due to Paperless Management.
9. Better Intra and Inter Hospitals/Clinics/Research Labs Communication.
10. Easy to retrieve and consult using Patient’s long medical history.
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ICT705 Data and System Integration - Assignment 1
Information Management and Integration
Tons of Information is recorded into the EHR, whether it is Structured Data and Un-
Structured Data. Structured Data captured in a specific format or structure, which directly
shows meaningful information when queried. Un-Structured Data recorded as a free text,
without any specific format or structure. Like Nursing Notes, Doctor Notes, Progress Notes,
Discharge Summary, Historical Notes, Physical Examination notes, Admission Assessments,
Hospital History Notes, Attestations, and Letters.
Structured Data is the Statistical Data of Patient like Date of Birth, Date of Admission, Date
of Discharge, Height, Age, Sex, and Weight, recorded into a specific format and at a different
pre-defined location.
Data Mining and Data Abstraction Tools are Integrated and used to extract meaningful
information from Patient records.
Text Mining Tools like MedLee, MetaMap, can recognize clinical terms within EHR and
map them to controlled clinical vocabularies, like ICD9, ICD10, and SNOMED.
Possible Solutions:
Creation and Implementation of standards for the EHR are required. One of the example in
Healthcare Industry is, The European Medical Information Framework (EMIF) aims to create
a standard Medical Information Framework to share and link medical data across diverse
Information Resources, including Databases and HER (Urbaczewski, Mrdalj, 2006)
State of the art technologies like NLP Natural Language Processing, OCR, NoSQL, and
Machine learning is used to analyze and process Un-Structured Data. Data preparation,
cleaning, normalizing and processing of the Un-Structured Data is to derive meaningful
information. Ontologies are developed to support healthcare based industry for vocabularies
like ICD9, ICD10, and SNOMED. This, in turn, used for better Analytics.
One of the technologies named, OCR (optical character Recognition), converts electronic
images of handwritten or printed text into the machine-readable form. Some of the best
OCR’s can directly extract meaningful data from the scanned image directly into the EHR
system.
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ICT705 Data and System Integration - Assignment 1
NLP (Natural Language Processing) is a more complex technology to identify key elements
from Un-Structured Data into meaningful Information using complex Computer Algorithms.
NLP is more accurate than OCR and scores a better winning percentage to extract accurate
Information. It converts Un-Structured Data into discrete data fields by identifying key
elements/concepts and their relationship in Healthcare documentation.
Machine learning can benefit the Healthcare Industry by means of Data Synchronization,
Analysis, and Innovation.
Enterprise Integration:
Enterprise Integration achieved by physically and logically interconnecting devices to the
computer networks, applications, database systems, necessary to extract data from structured
and unstructured data for analysis.
One of the Enterprise Integration model adopted is The Open Group Architecture Framework
model (TOGAF) (Abdallah, Hassan, and Edeen, 2006) in the Health Care Industry across the
world. It uses a holistic approach to design, model data and Business Systems, Applications
and state of the art technologies for Integration. It is suitable for large-scale systems.
Major components, which should be a part of the integration strategy, are:
1. Single Sign-On: Used for Authentication and Authorization, to access Applications
and the Data.
2. Compliance Engine: Which controls data flow between applications.
3. Master Index Identifier: a unique Identifier for every person in the database.
4. Database: A Central Data Repository to store person’s data and applications data
including the Master Index Identifier Information.
5. Protocol: A common set of code to exchange Information across multiple application
platforms (Panetto, Cecil, 2013).
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ICT705 Data and System Integration - Assignment 1
Conclusion
EHR offers unmatched benefits to the Healthcare Industry. Ranging from better Medical Care
to Patients, Decision Making Process to Medical Practices including Research, Scalability to
Inter-Operability of the System, Diagnostic Accuracy to Medical Costs.
As per the study in 2011, EHR had helped Doctors to avoid medication errors in their
practice. It has helped better communication and coordination with Patients and Inter
Hospitals.
Of course, Data Security and Integrity of data enhanced by the EHR. However, instances
have occurred where Hackers found stealing patient’s data. In 2012, Utah Health department
Server was hacked and this breach has compromised 800,000 citizens’ confidential data,
which was 25% of the population of the entire state. Safeguarding of citizens Dataachieved
by implementing security controls within the system.
Despite challenges, EHR will play an important role in the Healthcare Industry with respect
to the highlighted discussion in the above Project and has many advantages and benefits of
implementing Cloud-based or SaaS-based EHR.
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ICT705 Data and System Integration - Assignment 1
Recommendations
Cloud Computing is one of the growing fields due to its low-cost infrastructure support and
provides multiple benefits in relation to Infrastructure, Servers, Storage, Network, Security.
By adapting, Cloud-Based or SaaS-based EHR Healthcare Industry will get a boost with
reduced costs and administrative management and easy availability from almost anywhere.
Therefore, it is recommended to implement Cloud or SaaS-based EHR.
In addition, It is recommended to Integrate text-based analytical tools to capture and convert
unstructured data into meaningful information. Moreover, to make standards to cover as
much information as practically possible in form of a structure, which is easily recognizable
and further analysis is easily possible on it.
Make use of ontologies developed to recognize clinical vocabularies and existing Enterprise
Framework, which has fewer limitations compared to others.
Changes in disruptive technologies will bring, more new ways to help implement EHR.
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ICT705 Data and System Integration - Assignment 1
Bibliography
1. Healthcare’s UnStructured Data Problem
2. A Hybrid Solution for extracting structured medical information from unstructured
data in medical records via a double entry system, Ligang Luo, Liping Li, Jiajia Hu,
iaozhe Wang, Boulin Hou, Tianze Zhang, Lue Ping Zhao
3. Unstructured and Structured Data Healthcare
4. Challenges and Possible Solutions for Healthcare Industry
5. Healthcare Integration Strategy
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ICT705 Data and System Integration - Assignment 1
References
 Abdallah, S., Hassan G., Edeen G.(2006). Towards a Framework for Enterprise
Architecture Frameworks Comparison and Selection. The Fourth International
Conference on Informatics and Systems (INFOS2006), Faculty of Computers and
Information, Cairo University
 Urbaczewski, L., Mrdalj, S. (2006). A comparison of enterprise architecture
frameworks. IACIS(IIS) Volume VII, No. 2, pp. 18-23
 Pessi, K., Magoulas, T., Hugoson, M. (2011). Enterprise Architecture Principles and
their impact on the Management of IT Investments. The Electronic Journal
Information Systems Evaluation Volume 14 Issue 1, (pp53-62
 Panetto, H., Cecil, J. (2013). Information Systems for Enterprise Integration,
Interoperability and Networking: Theory and Applications. Enterprise Information
Systems 7, 1 (2013) pp. 1-6.
 Sajid M., Ahsan, K. (2014) role of enterprise architecture in healthcare organizations
and knowledge-based medical diagnosis system, , Federal Urdu University of Arts,
Science and Technology Karachi, Pakistan.
 Cho, I., Kim, J., Kim, J., Kim, H. Y., and Kim, Y. (2010).Design and Implementation
of a Standards-Based Interoperable, Clinical Decision Support Architecture in the
Context of the Korean EHR. Int. J. of MedicalInformatics,pp.611–622
 El-Sappagh, S. H., and El-Masri, S. (2014). Distributed Clinical Decision Support
System Architecture. Journal of King Saud University - Computer and
InformationSciences, pp. 69–78.
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