The file management structure as part of E-health system

Saima Munawar (2018-MSCE-03)

Rabeea Fayyaz (2018-MSCE-04)
Fatima Mahmood (2018-MSCE-06)

Computer Science and Engineering Department

University of Engineering and Technology, Lahore

Abstract
Clinical data or healthcare information is a very huge and comprehensive data because every
individual whether it is old or young or child has its own clinical information in any country.
Everyday doctors diagnose new diseases and symptoms and people are fighting with these
diseases and find cures. The diagnosis, symptoms and treatment of many diseases are
acknowledged but due to some rare knowledge which is not available or lack of information
about patient status, the doctor would not figure out the exact disease. These files are useful for
storing huge amount of data or records for any organization and future reference and we can
easily find or retrieve these in our file management system. This study highlights the issues of
Health care system and the need to modernize it. In the end, we proposed an improved
framework to implement against the one projected in literature review.

Introduction

The thrust of technology made our life more comfortable. The technology transformation in
medical domain evolves within political, administrative and socio‐economic factors of any
country. In addition, technology introduced by using various platforms including e-Health,
Telemedicine and m-Health. E-Health technology provides facility to disseminate health-related
information, distributed among clinics, health care providers and patients. Although, e-Health is
a subset of telemedicine and m-Health. The importance of these state-of-the-art technologies
towards improved health care systems and quality of life is highlighted through this call. The
country’s heath care institutions must work as an allocative body for the well-being of citizens.

Consider a medical patient scenario, if our friend is sick and he went to doctor for his checkup.
He enters the physician clinic and fills his demographic information like name, address,
symptoms and allergies. All this information on a paper chart is sent to a doctor for review and
examine or diagnose the patient disease or cause of disease. Now the doctor recommended a few
tests for a patient and ask to see him in few days. The doctor now writes its prescription on bingo
chart based on his test reports. In physician Office now the patient file is in the settling process
for a long time because every time any information regarding this patient is received, it must be
stored in his record file. Due to this system an after a few years there must be a huge number of
paper stacks, each paper has record about the specific patient and a point come where we are
unable to handle or manage these files electronically and the consequences are misplacement of
files; files lost and time-consuming searches.

To overcome this problem, we proposed EMR (Electronic management record) data management
system. To solve the data management problem in clinics and in hospitals EMR (Electronic
Medical Record)/ EHR (Electronic Health Record) provides a vital role. The technology behind
EMR/HER is Blockchain concepts which plays an effective in storing, maintaining and
retrieving large amount of data and the concepts of E.T.L (Extraction Transformation Loading)
schema.

In Electronic Medical Records, all the data or information regarding patients is collected in the
form of charts or on papers. In medical clinic or hospital offices there are miles of papers and due
this huge amount it is difficult to manage and retrieved these records. The Medical record of
patients in electronic format is term as Electronic medical record, these Electronic records are
easily accessible, manageable and it is easy to transfer data from one system to another.

EMR/ EHR makes a world of healthcare easy to manage, all the clinical data processes will be
automated, well structure and in organized form. This will help physicians to get certain
information about patient in less time, patients to get better treatment and prescription and
because of these amendments in hospitals or clinics we can improves the performance of overall
medical system. Electronic Medical record is getting most attention in the world due to its
numerous advantages in industry, offices, medical field and in companies.

In the “Literature Review” Section, we discussed about the technologies and researches
conducted in the past years. In the “Conclusion”, we critically analyze the research papers and
proposed a new solution.

Literature Review

During the past years, lots of researches conducted to implement and improve the E-Heath
Infrastructure. Out of the 25 publications 7 were repeated, the remaining 13 researches were
analyzed and read their studies to determine the concerned interest, 10 publications which gave
rise to appropriate contribution.

Randall Reese, Beaumont published a patent in 2017 as “READABLE MEDIUM, AND

COMPUTER - IMPLEMENTED METHOD FOR FILE MANAGEMENT, STORAGE, AND
DISPLAY” [1]. They describe file management machine as a server which can be used to
retrieve and accept user files and electronic data. It also facilitates to capture the user and visitor
activity. The visitor user is the one authorized entity by the user itself to share some unknown
specific files. The conducted research comprises of file organization and management,
specifically program products, a machines and approaches of file management, display and
storage. The proposed method is responsive to the problems associated with unorganized,
unsorted and underutilized files including but not limited to photographs. They presented file
management server as a machine or computer from the user configured. A first computer is used
as a server to communicate with multiple users through a communication network. File
management server comprises of one or more processors and memory elements. There are
multiple categories that could be associated with files adding and deleting by user itself. The
basic pre-defined categories relate the life and health of the user. The additional one might be the
status of marriage, children, school, faith, friends, books, sports etc. When a user adds unknown
file, it is categorized and sorted across the palette boundary to one of the pre-defined categories.
It can be categorized with more than one label.

William J . Raduchel , Palo Alto , CA ( US ) proposed a patent named as “RECORDS

ACCESS AND MANAGEMENT” [2] . The information against a user holds multiple files
from numerous medical devices. It displays as a single set of records. The access permission
either given by user itself or entertained by valid license for medical service center. It will also
helpful in case of emergency as the health care providers can access the data against patient
under issued license. The medical data is gathered from the health care providers and it’s a tough
and time-consuming task. The number of files on a computer can be huge. Effective management
of these data implies the presence of a clear logical structure. In case of health care data of each
patient it becomes more important to properly managed and organized. Various techniques are
proposed to gather information regarding specific patients. An initial process is initiated by the
first electronic device associated with the patient itself. An authentication token is facilitated to
established connection for transmission. The second request is made to engage with more than
one electronic device. The second request is different from the previous one as it includes the
stored authentication token. The first and second device request is able to deny the request. To
access the second patient data with second request is entertained by password and the ID of that
particular patient. The preferences are set for the patient in case of any emergency as the records
can be accessed from the electronic storage. The level of access is determined by the level of
emergency. Several researches are conducted to gather medical records with the mobile devices.
It may be helpful in a real-time domain. When a patient goes to a doctor, he can access his
mobile device to provide the required data to the doctor. In case of emergency, the data can
access from the mobile of the patient. In this case, a request is made and granted by database
providers. The different database providers (pharmacy, hospitals etc) send data to the requested
user. It can provide the facility to the user to add or modify data. In case of security and privacy,
the record is saved to different location and the third party receives a proxy and gets a single file.
The name of the patient is also removed or hides to achieve privacy. The code or proxy is
provided by emergency service providers. Two methods are available to access the data in case
of emergency including code by emergency service provider and he second is the valid license
key. The code will be hidden to achieve a secure network having secure ID of patient. The
network structure incorporates local/ide area networks, Public switch telephone network (PSTN),
Integrated service digital network (ISDN) Satellite, radio, Asynchronous transfer mode (ATM)
and Internet protocol(IP). A computer-based token generated method is also presented. It
encodes the data having the identifier through the wireless medium. The first request is made to
access the device storage.

The research paper on the “Logical Structure of the Software File Archive Formation as a Part of
Industrial Management” [3] is written by Roman V. Paliy1, Ernst S. Spiridonov 2, and Natalia A.
Telyatnikova3. In this research they demonstrate the utilization of archive file management
system in different organization. They proposed a file management framework that allows users
to access files in a secure way. They discussed the proposed system for multiple operating
systems. The implementation of the file system concerned the issues of linking the file and its
data blocks; file sharing and disk space management; with logical disk blocks.

In any organization, number of files is stored on the disk by multiple users. Effective
management of these data requires clear logical structure. Multi-level system is proposed
including owner, staff and the rest. Names, file structures, ways to access them, and their
attributes are important aspects of file system organization.
The files can be named unique in any directory but same within different directories. The
management of files in case of gigabytes of data on the disk makes it more complex. When these
files are not an ordinary one but the root of archives, typical processing of path names need to be
changed according to requirements. The data requires protection and reliability from any
physical damage. In case of list which defines the access of files against each user, processing
would be slows down. With increased number of users, it took time to allow the access listed.
All the pieces of their work are not fit together logically. This is the review paper on Archive file
management systems which demonstrate its advantages and disadvantages in any organization,
and they do not provide reliable results and clear instructions of implementation.

Ebtsam Adel, Shaker El-Sappagh†and Sherif Barakat proposed research based on

“Electronic health record semantic interoperability”[4]..The main objective of EHR is to give a
medical care record that represent both current and time ahead care prescribed by a doctors from
different clinics .It converts the framework of medical services from a paper-based format to a
digitalized or electronic format.
Modern technology have brought improvement in the medical domain,it provide large amount
of medical data from different heterogeneous providers such as monitoring, diagnosis, clinical
notes, billing community and many other . It combines all patients data from heterogeneous
systems[5].In an urgent need to retrieve patient data or in emergency we utilize interoperability
in EHR systems that has many benefits [6].In EHR system patients can access or retrieve their
medical history and medical data at any time and at any hospital, this reduces healthcare cost, w
management time ,time required for making medical decisions, clinical risks and reducing
duplication to save time.The ability of the receiving system to understand or interpret the
meaning of transmitted data is called semantic interoperability,but there is a problem of
heterogeneity because each system have its own main program and have different database
management system and standards,so its time consuming and difficult for a system to interpret
every type of data.

George Suciu1,Victor Suciu1 and Alexandru Martian1 proposed an Architecture for Secure
E-Health Applications [7].Cloud computing systems manages huge or big data storage and its
processing .The advancement in the field of internet of things (Iot) brought immense
development in Machine to Machine(M2M) communication and enabled novel telemonitoring
architectures for E-Health applications,but still there is a need to combine current cloud systems
and IOT systems.The main purpose of this paper is to evaluate or analyse evaluable methods of
securely managing or processing huge data of medical system by using cloud M2M systems
which are based on Remote Telemetry Units (RTUs) and to proposed a E-Health architecture
which is basically a search based application based on cloudview.

Amir M. Rahmani a,b, *, Tuan Nguyen Gia c , Behailu Negash c , Arman Anzanpou proposed
the Future Generation Computer System[8].Current advancements in ICTs i.e. advancements in
Internet-of-Things and Cyber–Physical Systems (CPS) enable us to manage health care storage
system more intelligently,with high accuracy and prediction capabilities for daily life
(home/offices) and in hospitals.A bridging point (gateway ) in most of Iot based health care
systems,especially in hospitals is required between sensor network and internet.
Gateway which is located at the edge of network structure translate the protocols used between
sensors and internet for communication and these gateways control over sensor infrastructure
network and data which is going to be transmitted through internet. In this paper, we exploit or
analyses the gateways position or location at the edge of the network to offer many higher-level
services such as local storage, real-time local data processing, embedded data mining, etc. Thus,
we are presenting a Smart e-Health Gateway.

Blockchain offers many benefits in the IT heath sector. It is an open source software, developed
by experts. It is transparent, reliable, responds faster against speedy changes that couldn’t be
chased by using closed and patented software. Open-source software offers wide innovation and
possibilities of choosing options according to need and demands. Blockchain technology run on
the commodity hardware, provides low cost high computation. They built by various vendors
based on open standards. They are based on best practices in the market because they are easy to
implement and discard the complex point to point data integration. Patients, health care entities,
research community can share their accurate data timely. This technology has been accepted and
analyzed as a secure and efficient system across many private and government agencies.

In Blockchain for Access Control in e-Health Scenarios [9], they solve the access control issue in
E-health system. It is a cardinal problem in the E-health system whereas, various data and
resources are distributed among various organizations. They describe that blockchain can helps
to solve this problem as it is a viable approach to store transaction and access control policies.

Sun, Y., Zhang [10] works on the identity verification and data authenticity in E-health system. A
DABS scheme is proposed to present a better approach. Off-chain, on-chain is also proposed to
foe verification and efficient storage of large-scale distributed data. However, the results show
practical and effective.

In [11] Wang, H., and Song describes a blockchain based framework to secure the E-health
system. Identity and attribute-based Encryption (IBE) is proposed for the security purpose.
Digital signature is secured and identified with the help of proposed encryption. It reduces the
effort of cryptography and ensures traceability and integrity of heath data.

In Privacy-Preserving Data Sharing in e-Health Systems via Consortium Blockchain [12], they
introduce blockchain as private and consortium that helps to improve the privacy and security of
E-health system. The private blockchain facilitate personal data (PHI) whereas, consortium one
was used for saving PHI indexes. The availability of the system ensures through block
generators. However, the results achieve security objectives.

Conclusion
E-heath is an umbrella for connecting patients, doctors, research community and government
agencies. The current interoperability challenges in the health care sector can be solved with the
help of blockchain. Blockchain allows individuals, health care providers and researchers to share
health data in a secure way. In this report, we proposed a e-health system architecture that will
not only improves the security of data but also facilitate IT sector and research community. A
blockchain based access-control manager is proposed to keep store health records that would
share nationwide Interoperability roadmap. Interoperability is a cardinal factor of any system that
deals with Precision Medicine Initiative (PMI) and the Patient Centered Outcomes Research
(PCOR).
Blockchain based IT infrastructure has come forward to increases the potential development of
precision medicine and advance medical research. Blockchain is a digitalized and decentralized
technology that forms a shared database to store data.

It has three main components: a distributed network, a shared ledger and digital transactions. The
first layer consists of participant nodes that stores an identical copy and helps collectively
towards certifying and validating digital transactions for the network. The second layer allows
record to be stored. These transactions are verified by the members who run algorithm to add
new ones.
The excess hardware capacity of multi-layer blockchain could be helpful for resource allocation,
privacy and reliability results faster solution and processing time. Multiple incentives and
benefits will promote hospitals to develop solutions that allow for patient’s data to be reachable
across different hospitals, and not just within a single health system and hospital.
Utilization of our proposed method has enough potential to connect millions of users, health care
entities, health care providers and medical researchers to share vast amounts of heath data,
genetics, lifestyle, diet with guaranteed privacy and security.
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