Implementing security in a distributed web-based EHCR

In many countries there are initiatives for building an integrated patient-centric electronic health record. There are also initiatives for transnational integrations. These growing demands for integration result from the fact that it can provide improving healthcare treatments and reducing the cost of healthcare services. While in European highly developed countries computerisation in healthcare sector began in the 1970s and reached a high level, some developing countries, and Serbia among them, have started computerisation recently. This is why MEDIS (MEDical Information System) is aimed at integration itself from the very beginning instead of integration of heterogeneous information systems on a middle layer or using HL7 protocol.

The implementation of a national healthcare information system requires using standards as integrated and widely accepted solutions. Therefore, we have started building MEDIS to meet the requirements of CEN ENV 13606 and CEN ENV 13729 standards. The prototype version has a distributed component-based architecture with modern security solutions applied. MEDIS has been implemented as a federated system where the central server hosts basic EHCR information about a patient, and clinical servers contain their own part of patients' EHCR.

At present, there is an initial version of prototype planned to be deployed at first in a small community. In particular, open source API for X.509 authentication and authorisation has been developed. Our project meets the requirements for education in health informatics, including appropriate knowledge and skills on EHCR. The points included in this article have been presented on several national conferences and widely discussed.

MEDIS has explored a federated, component-based EHCR architecture and related security aspects. In its initial version it shows acceptable performances and administrative simplicity. It emphasizes the importance of using standards in building EHCR in our country, in order to prepare it for future integrations.