A and/or organizational aspects (Finnegan and Hamid,

A SECURE E-PRESCRIPTION SERVICE FOR CLOUD
BASED

EHR SYSTEMS                           

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*M. P. Revathi

** P. D. Sheba Kezia Malarchelvi

* Assistant
Professor (SE.G): Dept. of Computer Science and Engineering

** Professor: dept. of Computer Science and Engineering

[email protected],
[email protected]

ABSTRACT

In this paper an E-Prescription service is developed
with security and can be used in EHR (Electronic Health Records) system. This service
can be integrated into a cloud based EHR system to allow doctors and other
medical practitioners in the EHR system to generate, store and manage
prescriptions in a secure manner in the cloud storage. With this system, the
patient first registers and gets a unique id from admin. This unique id helps
patient, doctor and pharmacy to view the E-Prescription via a data controller.
Data Controller checks all updates and stores data in the cloud in an encrypted
form. Whenever doctor, patient and pharmacy want to view the prescription, data
controller decrypts the information from cloud and helps them to view
E-Prescription.

 

Keywords:
E-prescription,
Data Controller, Encrypt and decrypt algorithm, Symmetric key, secure cloud storage

 

INTRODUCTION

Advances in the information and communication technologies have
provided considerable assistance to the troubles regarding healthcare services
(Li, 2012).  E-health
integration has been associated with various social, strategic, and/or organizational
aspects (Finnegan and Hamid, 2009). In this respect, there is a common tendency
to address e-health integration by an overall approach, seen as integrated
patient centre care (Leventhal et al., 2012). Integrated patient care centre
reflects on integrated e-health services requiring coordination across facilities,
professionals, support systems that are uninterrupted over time and between
patient visits (Singer et al., 2011). This approach is observed on
national healthcare strategies that support patient involvement in their
healthcare treatment. In
a technological respect the empowerment ensure through information-sharing, letting
the patients take their own measurements, offering the patients a visual
overview of their course of treatment, and letting them provide verbal and
written inputs (Clemensen et al., 2011). Based on the Service Oriented Architecture
(SOA) prototype e-health services can be exposed and run over cloud (in the
form of SaaS) (Poulymenopoulou et al., 2012). 

Electronic
prescribing or e-prescribing (e-Rx) is the computer-based
electronic generation, transmission and filling of a medical
prescription, taking
the place of paper and faxed prescriptions. E-prescribing allows a pharmacist, physician,
nurse practitioner, or physician assistant to electronically send out a new
prescription or renewal authorization to a community or mail-order pharmacy. It outlines the aptitude to send error-free, precise, and
understandable prescriptions electronically from the healthcare provider to the
pharmacy.

E-prescribing is meant to reduce the risks
associated with traditional prescription script writing. By sharing medical
prescription information, e-prescribing seeks to connect the patient’s team of
healthcare providers to facilitate knowledgeable decision making. E-Prescription systems help doctors
to generate prescriptions on his laptop or PC and send it electronically to
pharmacies. By doing this the medical practitioner directly sends prescriptions
to the pharmacy and avoids the risk of losing prescriptions. E-prescribing offers clinicians a
powerful tool for safely and efficiently managing their patient’s medications.
Compared to paper-based prescribing, e-prescribing can enhance patient safety
and medication compliance, improve prescribing accuracy and efficiency, and
reduce health care costs through averted adverse drug events and substitution
of less expensive drug alternatives 1.

Although developed countries like the US, Canada , Australia and Russia
already have e-prescription systems in place, in developing countries like
India, normally a patient is given a written prescription in paper and he is
expected to safely carry it to the pharmacy from where the medicines are
procured. With such a manual system, the patient might lose the prescription or
the prescription may not be legible and hence the pharmacist may misunderstand
the handwritten prescription which introduces a chance that he might supply a
wrong medicine to the patient.  With the
E-prescription system the patient does not have to carry the prescription and
also the pharmacist does not encounter the difficulty of understanding the
prescriber’s handwriting. 

This paper presents an E-Prescription
service that can be used in an EHR system. The rest of the paper is organized
as follows: Section 2 highlights the related works used for E-Prescribing. In
Section 3, we present the proposed a new
framework for E-Prescription system. In Section 4 present the experimental
results and in Section 5, we present our conclusions.

LITERATURE REVIEW

An important
feature of e-prescribing is the electronic exchange of prescription data
between physicians and pharmacies which can potentially improve the efficiency
of the prescribing process and reduce medication errors. Barriers to
implementing this feature exist, but they are not well understood. Joy et al. (2011)
explored the recent physician practice and pharmacy experiences with electronic
transmission of new prescriptions and renewals, and identified the facilitators
of and barriers to effective electronic transmission of e-prescriptions and
processing of e-prescriptions by pharmacies.

 

Jennifer et
al. have studied and compared the number of clarification calls generated by pharmacist and the average time taken for pharmacist
clarification calls to prescribers for electronic medical record
(EMR)-generated and handwritten prescriptions. They conducted the study over a
period of 17 to 19 weeks on four   community pharmacies in St John’s,
Newfoundland, Canada and noted that 1.33% of handwritten prescriptions required
clarification and 0.66% of EMR-generated prescriptions. This proved that
illegibility was eliminated with EMR-generated prescriptions but they found
that clarification was still required for missing information (24%) and
appropriateness (51%). They concluded that advanced e-prescribing functionality
will enable secure transmission of prescriptions from prescribers to a patient’s
pharmacy of choice.

Health care organizations focused on
(Bens et al., 2012) integrated model of patient medical record information
system using health care standard information format for data exchange. Health
care organizations use a variety of IT applications and infrastructures which
always need to be updated as a result of rapid growth in health care services.
The diversification on how health care organizations maintain their operations,
especially on maintaining patient’s medical information resulted in the
difficulty of accessing patient’s data.

Hussain et al., (2013) designed and
developed the Smart Clinical Decision Support System (Smart CDSS) that takes
input from diverse modalities, such as sensors, user profile information,
social media, clinical knowledge bases, and medical experts to generate
standards-based personalized recommendations. The authors include Smart phone-based,
accelerometer-based, environment-based activity-recognition algorithms in order
to recognize users` daily life activities

The authors Marinos et al. (2013) introduced
the idea of combining the state of the art technologies like cloud computing,
Service Oriented Architecture (SOA), homecare telemedicine technologies, e-
PHR, e-Prescribing, e-referral and e-learning. The authors suggested that the combination
of these technologies will lead to an innovative integrated e-health platform
that delivers many benefits to the society, the economy of   the healthcare
industry and the research community.

Annie and Annesha (2014)
pointed out that E-prescribing has flourished due to the promise of improving
efficiency and decreasing prescription errors caused by its handwritten
counterpart and so far only 44% of doctor’s offices use paperless prescriptions.

Lidia Villalba Van Dijk et
al. (2011) have pointed out in their report submitted to the Agency for
Healthcare Research and Quality, U.S. Department of Health and Human Services, that
in Netherlands and UK, e-prescribing
started as a grass-roots technology in the late through various local,
decentralized initiatives of technology-minded General Physicians (GPs) and
pharmacists. They have studied the impact of the system Netherlands and UK
and   reported that e-prescribing came into
widespread use with substantial government support as one component of
computerized systems for both medical records and practice management systems. They
highlighted that these systems offered clear benefits to GPs in the context of
their payment requirements, and e-prescribing was an added benefit, saving
time, in particular, with repeat prescriptions.

PROPOSED E-PRESCRIPTION
FRAMEWORK

Figure 1 demonstrates the architecture
diagram of the proposed E-Prescription system. It has five entities namely doctor,
patient, admin, data controller and pharmacy. Patient-Admin communication is
established for patient registration. Once the patient got registered through
admin, the admin will provide a unique Id to patient. Admin can collect the
information from the patient and send it to the Data Controller where the
registered data is stored. These data are encrypted and sent to the Cloud Service
Provider to be stored on the Cloud Storage. After getting their unique Id,
patient can communicate with the respective doctor and doctor can analyze the
history of the patient. After appointment and examination of the patient, the
doctor generates  generates an
e-prescription.

 

Figure 1.  Architecture Diagram of E-Prescription System

 

The generated E-Prescription is sent to the
Data Controller. The Data Controller sends the prescription details to the
Cloud Service Provider (CSP) after encryption. The CSP then stores this
encrypted E-prescription in the cloud. When a patient approaches the pharmacy, the
pharmacy can get the patient’s unique id and using this id the pharmacy requests
the Data Controller to retrieve the e-prescription. The data controller
retrieves the e-prescription using the id provided and decrypts it using the
symmetric key of the corresponding patient. After seeing the E-prescription, the
pharmacy will hand over the medicine to the patient.

 

A.      Patient

This module facilitates the interaction of patient with the admin for
their registration. After the process is done, admin sends back a unique id to
the patient. After registration process the patient will be directed to the
respective doctor. Now doctor will analyze the patient history and prescribe an
exact medicine to the patient. Using their unique id, patient can request for
their medicine in the pharmacy. With this unique id, the patient can access the
E-Prescription by requesting the data controller.

 

B.      Admin

       Admin plays a
vital role in this system. Admin collects all the information from the patient,
generates and provides a unique id for an individual patient after registration
process is over. The collected information is updated by the Data Controller.
Admin also has doctor’s details which are maintained in the database and all
the information regarding patient and doctor are presented to the Data
Controller.

 

C.     Data Controller

The doctor views the patient’s history and
generates an E-Prescription which is sent to the data controller. It encrypts patient’s
& doctor’s information for secure cloud storage using AES (Advanced
Encryption Standards) algorithm and symmetric key. The data controller
generates a unique symmetric key for every patient and maintains it in it
database along with patient id. Whenever a E-prescription has to be uploaded to
the cloud, the data controller retrieves the corresponding key of the patient using
the patient id and encrypts it before sending it to the CSP for storage in the
cloud. Similarly, whenever the E-prescription has to be retrieved by the
pharmacy or patient or physician, the patient id must be provided to the data
controller which sends a request to the CSP along with the patient id. The CSP
retrieves the encrypted E-prescription and sends it to the data controller
which decrypts the E-prescription and provides it to the       requestor.

 

D.
    Doctor

         After examination
of the patient’s history, doctor can generate an E-Prescription and forward it to
the Data Controller. Doctors are provided with the right to edit a
prescription, so that doctor can make changes in the patient prescription. The
generated E-Prescription is uploaded by data controller in encrypted format to the
cloud. Whenever doctor wants to retrieve the E-prescription, data controller sends
request to the CSP and decrypts the E-prescription once it receives it from the
CSP. Doctor can edit & view the E-Prescription by using unique patient’s
id.

 

E.     Pharmacy

       In pharmacy module will fetch the patient’s unique id, using
this id pharmacy can view the patient       E-Prescription and provide a prescribed
medicine to the patient. Pharmacy having rights to view the prescription and
request the prescription details from data controller. Every pharmacy having a
stock maintenance section, whenever the medicine reduces to certain level it
alerts them by giving a pop up message on the local machine. Pharmacy
can view the E-Prescription by having patient’s unique id from data controller for providing medicine to
patient.

EXPERIMENTAL RESULTS

    The proposed E-prescription system is
implemented using ASP .NET and MySQL and hosted in 000webhost. Sample screen
shots of the proposed system are presented in figure 2 to figure 4.  Figure 2 shows the home page of the proposed E-Prescription
system. Users such as Patient, doctor, pharmacy and admin can use the system by
logging in.  The admin of this system generates
unique ID for every patient, doctor and pharmacy. The users can register with
the system by providing their username and password and later these information
can be used in the login process.  Figure
3 illustrates the admin login process. The doctor can view the patient’s
details based on the patient’s id. This is shown in figure 4.

 

 

Figure 2.  Home Page of E-Prescription System

 

 

Figure 3.  Admin Login Process

 

 

Figure 4.  Doctor’s View

CONCLUSION

The proposed work implements an
E-Prescription system that can be integrated to a hospital management system.  An E-prescription system offers the ability to send error-free, accurate,
and understandable prescriptions electronically from the healthcare provider to
the pharmacy and helps bridge the pharmacy, doctor and the patient. While
accomplishing this task, the proposed work also focuses on storing and
accessing the E-prescriptions on the cloud in a secure manner by employing Advanced
Encryption Standards algorithm. The secure storage and access is achieved through
a data controller located at the Health Service Provider (HSP).  A patient registers with the HSP, before
consults a physician and gets a unique id the first time he visits the HSP.
After consultation, the doctor generates the prescription which is stored on
the cloud after encryption which can be retrieved by the patient or doctor or
by a pharmacy upon producing a valid patient id to the HSP.  The proposed E-prescription system reduces
the burden of the patient from safeguarding the prescription and remembering to
carry the e-prescription to the pharmacy to buy medicines. It also reduces the
burden of pharmacist from having to put much effort to understand the illegible
handwritten traditional prescriptions.

 

REFERENCES

1 A Clinician’s Guide to Electronic Prescribing,
American Medical Association (2011), Retrieved from: http://www.ama-  
assn.org/ama1/pub/upload/mm/472/electronic-e-prescribing.pdf

1 E. Ammenwerth,, P. Schnell-Inderst, C. Machan, and U. Siebert, “The
Effect of Electronic Prescribing on Medication Errors and Adverse Drug Events:
A Systematic Review, ”  Journal of the
American Medical Informatics Association (15) 5,  pp. 585-600, 2008.

2 Bens Pardamean, Rizal Ricky Rumanda, “Integrated Model of
Cloud-Based E-Medical Record for Health Care Organizations, ” , 2012.

3  J.C. Crosson,, N. Isaacson, D. Lancaster, E. A. McDonald, “Variation
in Electronic Prescribing Implementation Among Twelve Ambulatory Practices, ”
Journal of General Internal Medicine (23) 4, pp. 364-371, 2008.

4  C.M. Cusack, “Electronic Health Records and Electronic Prescribing:
Promise and Pitfalls,” Obstetrics and Gynecology Clinics of North America (35)
1, pp. 63-79, 2008.

5  C. Doukas, Pliakas, T., Tsanakas, P. and Maglogiannis, I, “Propose
a distributed platform based on Cloud Computing for management of pervasive
healthcare data, ” 2012.

6 P.  Donyai, K. O’Grady, A.
Jacklin, N. Barber, “The Effects of Electronic Prescribing on the Quality of
Prescribing, “British Journal of Clinical Pharmacology (65) 2, pp. 230-237,
2008.

7  M. Hussain , Khattak, A. M., Khan, W. A., Fatima, I., Amin, M. B.,
Pervez, Z., Batool, R., Saleem, M. A., Afzal, M., Faheem, M., Saddiqi, M. H.,
Lee, S. Y. and Latif, K., “Designed and developed the Smart Clinical Decision
Support System (Smart CDSS) “, 2013.

8  M. Joy, Grossman, Dori, A., Cross, Ellyn, R., Boukus, Genna, R.,
Cohen, “Transmitting and processing electronic prescriptions: experiences of
physician practices and pharmacies”, 2011.

9  M.  Lee, Delaney, C. and
Moorhead,  S,”Electronic prescribing in
community pharmacies” ,2013.

10      Marinos Themistocleous, Konstantinos Koumaditis and Georgios
Vassilacopoulos, “Providing integrated e-health services for personalized
medicine utilizing cloud infrastructure”, 2013.

11 Jennifer L
Phillips, Jennifer M Shea, Valerie Leung and Don MacDonald, “Impact of Early
Electronic Prescribing on Pharmacists’ clarification Calls in Four Community
Pharmacies Located in St John’s, Newfoundland”, JMIR MEDICAL INFORMATICS,
Volume 3, Issue 1, pp. 1-8, 2015.

 

 

 

 

 

 

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