title: Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach.
abstract: BACKGROUND
  The integration of heterogeneous electronic health records systems by building an interoperable nationwide electronic health record system provides undisputable benefits in health care, like superior health information quality, medical errors prevention and cost saving.
  
  
  OBJECTIVE
  This paper proposes a semi-distributed system architecture approach for an integrated national electronic health record system incorporating the advantages of the two dominant approaches, the centralized architecture and the distributed architecture.
  
  
  METHODS
  The high level design of the main elements for the proposed architecture is provided along with diagrams of execution and operation and data synchronization architecture for the proposed solution.
  
  
  RESULTS
  The proposed approach effectively handles issues related to redundancy, consistency, security, privacy, availability, load balancing, maintainability, complexity and interoperability of citizen's health data.
  
  
  CONCLUSIONS
  The proposed semi-distributed architecture offers a robust interoperability framework without healthcare providers to change their local EHR systems. It is a pragmatic approach taking into account the characteristics of the Greek national healthcare system along with the national public administration data communication network infrastructure, for achieving EHR integration with acceptable implementation cost.
authors.forename: Leonidas L
authors.initials: LL
authors.lastname: Fragidis
authors.forename: Prodromos D
authors.initials: PD
authors.lastname: Chatzoglou
authors.forename: Vassilios P
authors.initials: VP
authors.lastname: Aggelidis
mesh_terms: D003195:Computer Communication Networks / Q000458:organization & administration*; D057286:Electronic Health Records / Q000458:organization & administration*; D006115:Greece; D006801:Humans; D018511:Systems Integration
keywords: Electronic health records; ehealth; interoperability; middleware; semi-distributed architecture; system integration