Harmonizing patient-centric requirements for secure digital health services in heterogeneous settings

Implementing electronic health services with a patient-centric focus while adapting to the know-how of local contexts is a challenge. This paper addresses this challenge by establishing a template of modular requirements for designing a viable Electronic Health Record (EHR) system that enables transmission and sharing of patient data across primary, secondary, and specialized care, ensuring versatility in diverse healthcare environments and across varying socio-economic landscapes. The research is anchored in design science and employs an action research strategy, using northern Brazil as empirical case. The approach builds on generic requirements from standards established by the European Union, Fast Healthcare Interoperability Resources (FHIR), and the Swedish ePrescription journal system. These requirements are refined and adapted to the Brazilian context through a participatory method, considering development disparities across municipalities and aligning with national policy. A key feature is the integration of knowledge graphs, which, when combined with fieldwork iterations involving healthcare professionals and patient association representatives, facilitated the extraction of patient-centric requirements. Strategies from Brazilian healthcare policies targeting chronic kidney disease, selected as a significant challenge for specialized healthcare in emergent areas, were incorporated to generalize the design of EHR modules aimed at prevention and monitoring of population at risk. Results support that harmonization towards legacy system is strongly advised and discourage the introduction of systems designed from scratch.