Bio-medical Ontologies Maintenance and Change Management

272 J.Y. Chen, S. Taduri, and F. Lloyd
This design has several advantages compared with existing systems. First, the
design incorporates multiple data sources, which can be derived from bulk
public directory information with hospital EMRs and personal PHR health selfmanagement
data; therefore, it can be used to develop comprehensive datadriven
patient-centric PHR applications. Second, the design converges on
robust database management system which underpins a set of functional
modules; therefore, the system is scalable and adaptable to changing individual
user needs. Third, the management of health data has extensive built-in security
and access control both at the database layer (Oracle DBMS functions) and the
application layer (encryption/decryption, authentication and authorization
engines). Fourth, the framework is very flexible and extensible; one can add
multi-media presentations such as treatment educational videos, mp3 audios for
latest treatment/health tips, and annotated image from pathology/radiology labs.
4 Usage and Functional Interactions
In the previous section, we showed a framework design which shows all the
components the PHO system should have in order to address current challenges in
developing PHO systems. In this section, we further show how the primary users
of this system could interactively use the PHO software. In Fig. 2, we show such a
system relies on a web server that serves various user requests via secure http
protocols. The system sets diffeent types of access privileges to three different
types of users, i.e., patients, physicians, and web administrators. Depending on the
type of user roles, the PHO system customizes user-specific interfaces and
functional features.
Key to this functional interaction paradigm is a new concept, Physicianmediated
Patient EMR Review. This new concept addresses the difficult problem
of enabling individual access to hospital EMRs, which traditionally is paper-based
and slow, because it needs to involve hospitals and HIPAA regulations. The
concept is an attempt to solve the problem, which is that hospitals own the
information content located in their protected EMRs yet don’t have all the right to
access the content, while individual users have the rights to access their own
records yet don’t own the information/software located in the hospital EMR. The
solution lies in introducing physicians into the interaction paradigm for two reaons:
first, physicians are pre-authorized to access hospital EMRs related to their own
patients legally; second, physicians are motivated to help their own patients access
their own records conveniently, if such help could bring satisfied patients, reduced
medical errors, increased patient cooperation, and increased efficiency while
receiving patients in the clinic. The concept works in the following five steps:
1. Request. A patient logs in his PHO system and issue multiple requests to
his/her physicians at different hospitals for permissions to access his/her
own hospital EMR data. He then logs out and waits for approvals.
2. Approve. One of the patient’s physician logs into the third-party PHO
system (not inside hospital EMR system) later and find several of patients‘
requests for accessing to different types of their medical records. The
physician either approves or denies access to his/her requesting patients.