title: An e-consent-based shared EHR system architecture for integrated healthcare networks.
abstract: OBJECTIVE
  Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model.
  
  
  METHODS
  A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented.
  
  
  RESULTS
  Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting.
  
  
  CONCLUSIONS
  The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.
authors.affiliation: Technical University of Braunschweig, Institute for Medical Informatics, Muehlenpfordtstr 23, 38106 Braunschweig, Germany. j.bergmann@mi.tu-bs.de
authors.forename: Joachim
authors.initials: J
authors.lastname: Bergmann
authors.forename: Oliver J
authors.initials: OJ
authors.lastname: Bott
authors.forename: Dietrich P
authors.initials: DP
authors.lastname: Pretschner
authors.forename: Reinhold
authors.initials: R
authors.lastname: Haux
mesh_terms: D003195:Computer Communication Networks; D016494:Computer Security; D003219:Confidentiality; D005858:Germany; D006801:Humans; D008491:Medical Informatics Applications; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D018511:Systems Integration