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I. Introduction
The increase in the desire for healthy life management and the information empowerment of consumers have fused with the rapid development in information communication technology and it is giving traction to the creation of a new health and medical environment that supports individuals to collect and manage their health information anywhere, anytime, and helps them with prevention and early discovery of diseases. In order to establish the next-generation healthcare system popularly called ubiquitous healthcare, research is actively being carried out on the development of a new platform and customized service that supports collecting, transmitting, processing, storing, and using health information without any space-time restrictions. Health and medical informatization is based on information digitalization. The U.S. Institute of Medicine (IOM) divided the development of electronic medical record (EMR) into five stages: Automated Medical Records, Computerized Medical Record, Electronic Medical Record, Computer-based Patient Record, Electronic Health Record (EHR)1). These days, however, as individual-centered medical care begins to receive more attention, Electronic Health Record is again evolving into Personal Health Record (hereinafter, PHR)2-4).
1. Concept of PHR
The PHR is still largely undefined and PHR models are still in their infancy. In 2003 as part of Markle Foundation's Phase I of Connecting for Health, the Personal Health Working Group defined the ideal PHR as: "an Internet-based set of tools that allow people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it. PHRs offer an integrated and comprehensive view of health information, including information people generate themselves such as symptoms and medication use, information from doctors such as diagnoses and test results, and information from their pharmacies and insurance companies. Individuals access their PHRs via the Internet, using state-of-the-art security and privacy controls, at any time and form any location. Family members, doctors or school nurses can see portions of a PHR when necessary and emergency room staff can retrieve vital information from it in a crisis. People can use their PHR as a communications hub: to send email to doctors, transfer information to specialists, receive test results and access online self-help tools. PHR connects each of us to the incredible potential of modern health care and gives us control over our own information5),6)." According to American Health Information Management Association (AHIMA), "the PHR is a tool that person can use to collect, track and share past and current information about their health or the health of someone in their care. Sometimes this information can save person the money and inconvenience of repeating routine medical tests. Even when routine procedures do need to be repeated, their PHR can give medical care providers more insight into their personal health story. Important points to know about a PHR are that: Person should have access to their complete health information; Information in their PHR should be accurate, reliable, and complete; Person should have control over how their health information is accessed, used, and disclosed; A PHR may be separate form and does not normally replace the legal medical record of any provider7)." The PHR as defined by the Key Health Information Technology Terms Project is: "[a]n electronic, record of health related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual8)." HIMSS defines an ePHR in its ePHR Definition and Position Statement by stating, "An electronic Personal Health Record (ePHR) is a universally accessible, layperson comprehensible, lifelong tool for managing relevant health information, promoting health maintenance and assisting with chronic disease management via an interactive, common data set of electronic health information and e-health tools. The ePHR is controlled, managed, and shared by the individual or his or her legal proxy(s) and must be secure to protect the privacy and confidentiality or the health information it contains. It is not a legal record unless as defined and is subject to various legal limitations9)."
In the event, PHR is the core of consumer-oriented medical service to save medical costs and enhance welfare by managing chronic diseases and preventing diseases while individuals manage their own information related to health for a lifetime and take care health by themselves and support decision making for medical treatment based on the health data accumulated during their lifetime.
2. Types of PHR
The previous researchers distinguished a "tethered" PHR (bound to a certain organization) from a "standalone" PHR and the ideal "interconnected" PHR.
(1) Standalone PHR
Standalone systems are generally considered to be those offered via the Web from a commercial vendor. Although an individual may provide access to a provider (or payer) for the purpose of helping to populate a (Web-based) standalone system, more often these systems rely on an individual or family member/caregiver entering information themselves. Such information may be copies of forms from a provider or payer that are scanned into the system or an abstraction from that information. Other formats of standalone PHRs also exist, such as on a flash drive, CD, or smart card; in a computer file with e-faxed or scanned documents; on Medic-Alert-type jewelry; or in an organized hard copy file of provider documentation or a paper-based health diary10). In its simplest form, the PHR is a stand-alone application that does not connect with any other system11-13).
(2) Interconnected PHR
The interconnected PHR can be populated with patient information from a variety of sources, including EHRs, insurance claims, pharmacy data, and home diagnostic equipment. Therefore, they can provide both consumers and providers a more complete view of relevant health information. The consumer is an important contributor to the interconnected PHR content and is allowed to enter information into selected areas of the record. Some interconnected PHRs are offered in connection with services related to a health condition or disease and feature patient data integrated with personalized health advice and guidance14).
(3) Tethered PHR
A tethered PHR is a subset of data compiled by a provider and other healthcare entity. The individual can access and update the tethered PHR. The individual provides his or her health information or sends pertinent documents to the PHR vendor to be filed in the record. These services allow password-protected access to records anywhere, anytime via an Internet connection15),16).
(4) Integrated PHR
The integrated PHR (iPHR) concept is supported by an increasing number of health information technology advocates because its transformative potential far surpasses the value proposition of the standalone PHR17),18). The major capabilities underlying iPHRs' potential as a transformative technology. Include patient/provider interactive communication, virtual integration between closed systems, care management, health knowledge promotion, portability, auto-population, and data sharing with authorized patient proxies19).
As a part of the effort to establish an effective and efficient PHR system, this paper has designed a system that incorporates web and mobile storage devices, and based on the experience of implementing the system, will describe its development method, results, and relevant issues.
II. System Design and Description
The system pursued by this study is 'integrated' PHR system. This was designed to support both online and offline environment. The purpose of this paper is to provide an individual a lifetime health record and thus help the individual to achieve increased health and disease prevention through self management. Lifetime health record includes not only to medical records produced at hospitals but also bio-information measured from various sensors while at home or during movement such as blood pressure, blood sugar, heartbeat, temperature, SPO2, ECG, and body fat, and it presupposes an information exchange network between hospitals and between sensors and servers. For safe information exchange, users can query patient records from more than one hospital when they want to without accumulating data, and they can also selectively save the queried information to their PC or mobile storage device. For this purpose, web servers were designed to only retain each hospital's index, log, and membership information.
The scope of development and exchanging data of this system is as follows.
1. PHR web server
The web server is divided into DB server and application server. It allows data exchange between individual and n hospitals through web service interface module for each hospital. The medical treatment information is not saved in the web server, but the vital sign and calorie information will be saved in the DB server20). The hospital information exchange network of this system is as Figure 1.
2. Medical treatment information inquiry system
The scope of data which can be inquired by users from more than one hospital is hospital visit history, prescription history, diagnosis result, image examination result, medical treatment result, hospitalization/discharge description, and reservation information. These are reflected by the output of PHR data sets from the previous researchers21),22).
The Figure 2 shows the Data Flow Diagram of the medical treatment information inquiry system.
3. Client's PHR program
Users can inquire medical treatment information through the PHR program installed in their PC or USB (Universal Serial Bus) flash drive, and save the data into the PC or USB flash drive. Also, it supports managing chronic diseases and diet through vital signs including blood pressure, blood sugar, pulse, body temperature, SPO2, ECG and body fat, and input, inquiry and management of ingestion and consumption of calories.
III. Results
1. Development environment
Microsoft Visual Studio 2003 was used as server to develop the system in .NET environment, and Microsoft Windows XP Home or Professional operating system with Code gear Delphi 2007 Enterprise (Update 1) was used as client. The SOAP (Simple Object Access Protocol), file compression, and encoding technique based on Microsoft Office Access 2003 database were used. The client program was developed device-independently and not influenced by USB flash drive type.
2. Operating mechanism
The Client uses WSDL (Web Service Definition Language) to call web service. Then XML (eXtensible Markup Language) data is returned, and the transmitted XML is encoded to express data queried by the user and stored in USB flash drive. The mechanism is shown in Figure 3.
The specific operating process of PHR system is shown in Figure 4.
3. Data transmission process
The communication process repeats the following steps ①-⑦. ① Information being queried is inputted (e.g. when querying patient record, input start and end dates for the query) and a function is called. ② The called function uses WSDL (Web Service Definition Language) to call the relevant web service function. ③ When it is called, the web service function is carried out using SOAP (Simple Object Access Protocol). ④ As the function is executed, the needed data is queried in the database and results are returned. ⑤ The returned results are stored in XML format and, using SOAP, are transmitted to the client that called. ⑥ A parser is used on the transmitted XML to translate them into a dataset format. ⑦ the translated dataset is expressed on a grid. ⑧ When other information is queried, steps ①-⑦ are repeated.
4. Design PHR program user interface
Individuals can connect to a web server and query and download information such as patient record, examination results, and medication prescriptions, and even when they are not connected to a network, they can query their mobile device and input bio-information. To enable users to effectively their PHR when they end up visiting a hospital during an overseas business trip or in an emergency situation, a mobile storage device-based PHR plug & play viewer was developed (see Fig. 5 and Fig. 6). User convenience was considered in allowing accumulated data to be queried using a visual statistical graph according to various search conditions.
5. Personal emergency information
Since the portable PHR program divides the data domain into disclosed domain and non-disclosed domain, if the user is under emergency situation, then any one can obtain the portable PHR program and find out the information saved in the disclosed domain (main hospital, contact information of the hospital, the information of the attending physician, blood type, allergy, emergency contact information and information of guardian). Therefore, this allows immediate and precise evacuation and treatment, and this is one of characteristics of this system.
6. Standardization
In order to standardize the exchanged data, HL7 Version 3.0 is applied when inputting and inquiring vital sign, and inquiring the diagnosis inspection to enhance the interoperability of information exchange between heterogeneous systems.
7. Information protection
In order to guarantee the confidentiality, integrity and availability of information, the improvement of information control has been selected as the biggest goal. Accordingly, it was developed to save and manage information in individual PC or USB flash drive according to individual intention instead of accumulating information on web server. Encrypted module is applied to the transmission zone of data, and the encryption of saved data is also implemented. The certificate authorization method is adopted additionally to the password authorization, and all passwords are encrypted in oneway to maximize the technical information security.
IV. Discussion
The combination of increasing interest in health and spectacular advance in technology is changing the paradigm of medical treatment. With the conversion in the flow of medical treatment, from the existing "medicare" environment where the patient with illness seeks out a hospital for treatment to the concept of "lifecare" where the consumer now self-manages health and prevents disease and the hospital seeks out the patient, the PHR service is nascent. On the other hand, the concerns about information leakage has grown serious as well. The personal health information is sort of the most sensitive information and must be maintained throughout the reliable and secure process.
This paper designed and developed a web and mobile storage device-based lifetime PHR that enables individuals to manage their health information by themselves anytime, anywhere, on-line or off-line, by providing a tool for individual-centered lifetime health information management. The advantage of this system lies in the fact that it connects hospitals and home & mobile healthcare while minimizing the dangers of information leakage by not accumulating data, and supports a sustained health management by loading a plug & play PHR viewer to a convenient mobile storage device. Since this is not dependent on hard ware, it can be used in any PC or USB flash drive.
The OCR (Optical Character Recognition) synchronization program needs to be developed to enable the integrated management of treatment records in paper form (prescription, checkup results, and diagnosis) and in order to convert that information into digital data to be managed with the existing data in response to the poor medical status of direct information communication between medical organization due to various reasons such as policies and standards to maximize information communication. For future research, feedback through demonstrative operations using actual users and work on adjusting and supplementing the system are being planned, as well as the development of a PHR system using universal subscriber identity module and CDMA (Code Division Multiple Access) method based mobile phones.
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