emedyx Emergeny Smart Card EMR System: Card Holder Module

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1 CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 1 emedyx Emergeny Smart Card EMR System: Card Holder Module Elizabeth D. Ruetas and Joseph Anthony C. Hermocilla Abstract The emedyx system is an Electronic Medical Record (EMR) designed in a more secured way with the use of Smart Card and Biometrics technology. The implementation of the whole system will be subdivided into modules. These modules are focused on the different aspects of emedyx - Card Holder Module which covers the patients information; Security Module which ensures the overall security of emedyx; Logs and Reports Management module which focuses on report generation and major logs of emedyx; and ID Management Module which focuses on the secured generation of cardholders and organizations ID. This study aims to create a module of emedyx that will allow the users - card holder, physicians, administrator - to issue cards, login to web application using the card issued and to do administrative tasks to the web application such as entering, viewing, and modifying user data according to their classification. This system written using php and C#, uses SOAP web service to integrate the desktop and web applications. One feature of this module allows the administrator to issue cards to cardholders through a C# application that uses web service to get the correct data that will be written to the card. This cards when issued will then be used by the card holders to login to the web application. Index Terms emedyx, Electronic Medical Record (EMR), web application, smart card, web service I. INTRODUCTION In the United States of America, an act called Health Insurance Portability and Accountability Act also known as HIPAA became a law in This law covers the protection of health insurance of workers and their family when they change or lose their jobs. In order to secure the effectiveness of this law, the Administrative Simplification gave an order that the establishments should have national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employees [1]. Electronic health care transactions are mostly implemented as web applications. The reason for this is because the Internet is the cheapest and most accessible media in the country. Through out the years, web applications for electronic health care transactions became popular in the country and nowadays it is called electronic medical records (EMR). Even though EMR is popular, security issues about data handling arise. Security vulnerabilities of web applications Presented to the Faculty of the Institute of Computer Science, University of the Philippines Los Baños in partial fulfillment of the requirements for the Degree of Bachelor of Science in Computer Science cause the data to be visible and easily targeted by hackers. emedyx system is also an EMR that aims to lessen this issues with the use of Smart Card and Biometrics technology. It will also be implemented as web applications integrated with standalone applications. In this module, to lessen these security issues we used smart cards and web services. A standalone application was developed using C# to issue cards to the cardholders. Using this application, some personal and contact information of the cardholder were written to the card that will later be used to login on the web application. Another standalone application was developed using C# to view the information written to the card and to login on the web application using the card. This is to ensure that the user can access his account and modify information he is allowed to modify. It is also to verify that the user accessing the web application is a cardholder. II. OBJECTIVES OF THE STUDY The main objective of this study is to implement the cardholders module of emedyx. The cardholder module should be able to: 1) issue card to the cardholders; 2) limit the user who can access the patients information; 3) allow cardholders to connect to the web application using smart card; 4) allow modifications on medical information of the patient; 5) reflect every modifications done in the patients record; III. REVIEW OF RELATED LITERATURE A. Electronic Medical Record Electronic Medical Record (EMR) is a computerized legal medical record created in a care giving organization. It is a part of a local standalone health information system that can store, retrieve and manipulate records. Electronic Medical Record (EMR) is widely used in the US to comply with the Health Insurance Portability and Accountability Act (HIPAA) which deals with privacy of medical records. Some examples of EMR are Veterans Health Information Systems and Technology Architecture (VistA) and, New York City Health and Hospitals Corporation [2]. As of 2006,

2 CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 2 national and state archives authorities are still developing open, non-proprietary technical standards for electronic records management (ERM).Though there are few standards for modern day EMR systems as a whole, there are many standards relating to specific aspects of EMRs. These include [3]: ASTM International Continuity of Care Record a patient health summary standard based upon XML, the CCR can be created, read and interpreted by various Patient portal systems, allowing easy interoperability between otherwise disparate entities. ANSI X12 (EDI) A set of transaction protocols used for transmitting virtually any aspect of patient data. Has become popular in the United States for transmitting billing information, because several of the transactions became required by the Health Insurance Portability and Accountability Act (HIPAA) for transmitting data to Medicare. CEN CONTSYS (EN 13940), a system of concepts to support continuity of care. CEN EHRcom (EN 13606), the European standard for the communication of information from EHR systems. CEN HISA (EN 12967), a services standard for intersystem communication in a clinical information environment. DICOM a heavily used standard for representing and communicating radiology images and reporting. HL7 HL7 messages are used for interchange between hospital and physician record systems and between EMR systems and practice management systems; HL7 Clinical Document Architecture (CDA) documents are used to communicate documents such as physician notes and other material. B. Smart Card Technology Smart Card is any pocket-sized card with embedded integrated circuits which can process data. It can be used for identification, authentication, and data storage. Also, it provides a means of effecting business transactions in a flexible, secure (strong authentication), standard way with minimal human intervention [4]. Smart cards are usually like a credit card in size (85.60 x53.98). The inside of a smart card contains an embedded microprocessor. It contains a tamper resistant security system that is capable of providing security services. Smarts cards may have up to 8 kilobytes of RAM, 346 kilobytes of ROM, 256 kilobytes of programmable ROM, and a 16-bit microprocessor. The data inside the card is read through different card reading devices [5]. Some present applications of smart cards are credit cards, electronic cash, computer security systems, wireless communication, loyalty systems (like frequent flyer points) banking, satellite TV and, government identification. Today, smart cards are more popularly used in Europe than in US but because of the increasing demand of data security. Smart cards now are beginning to be popular in US. C. Web Services Web services are web API accessed via HTTP and executed on a remote system hosting the requested services. Web services can either be Big Web Services or a RESTful Web Services. On our case, the web services we used is Big Web Service. In Big Web Services, Extensible Markup Language(XML) messages that follow the Simple Object Access Protocol (SOAP) standard are used. Most often this system has a description of the operations offered by the service written in Web Services Description Language (WSDL). It is not a requirement of a SOAP endpoint but it is a prerequisite for automated client-side code generation in many Java and.net SOAP frameworks [6]. Web service may be a requester, provider, and intermediary depending on the context of the Web service transaction. It is a requester web service if it initiates a web service transaction on its own. It is a provider web service if it accepts a request from the requester and provides a response based on the input. The provider is responsible for setting the standards for authentication, authorization, encryption, and non-repudiation. The provider communicates its requirements through the extensibility of WSDL, a discovery service, or both. It is an intermediary web service if it is invoked in a chain [7]. For the purposes of our module, most of the web services used were a provider web service. The web services used on the system follow the SOAP format. SOAP is designed to be a new protocol for decentralised and distributed environment, which utilizes the power of the Internet and XML to pass typed information between nodes. SOAP is fundamentally a stateless, one-way message exchange paradigm between SOAP nodes, from a SOAP sender to a SOAP receiver. There are two types of SOAP requests. The first is the Remote Procedure Call (RPC) style request similar to other distributed architectures. This is usually synchronous; the client sends a message and waits to get a response or fault message back from the server. The second type of SOAP request is the document request. In this case, a full XML document is passed to/from the client and server, inside a SOAP message [8]. IV. MATERIALS AND METHODS 1) Hardware Requirements

3 CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 3 Each user will be issued an ACOS3 smart card where the users identification information is stored. The system will use an ACS Smart Card Reader ACR38 that will read the users smart card using C# programming. 2) Functional Requirements Each time the user (cardholder) access his medical information, the system will require him to login using his smart card. Whenever a modification of data is detected, the system will update and will reflect to the user what has been modified. 3) Non Functional Requirements The modifications done should be evident as soon as the data was modified. The information shown and written to card were fetched from the server database using SOAP web service. C. Standalone Application: Connect Web A separate standalone application written also in C# and built using Microsoft Visual C# 2008 Express Edition were also developed for the cardholders. This application allows the cardholders to view information written on his card as well as to login on the emedyx web application. This application will automatically login the cardholder to the web application using the information written in the card. Clicking the link connect to web will automatically login the cardholder to the web application. After verifying the login information of the cardholder, A web browser will be opened and the user will be redirected to the homepage of emedyx web application site. A. Web Application The web application was designed to allow users to add, view and modify data. It will have two main users: the administrator and the cardholder. The administrator can login on the web application login page. He can also add, view and modify data stored in the database. He can access every information for every organizations serviced by emedyx. Cardholder, on the other hand, can only view information related to him including his immunization records, medications and medical conditions. He can only modify his personal, contact and dependent information. The web application for emedyx was written and developed using PHP and MySQL. B. Standalone Application: Issue Card Before a card can be issued to a cardholder, the cardholder information should first be entered by the administrator to the database through the web application. After these, the card can then be issued to the cardholder. Using this standalone application, the administrator will choose from which organization the cardholder belongs. Based on the organization, a list of cardholders with no cards issued yet will be shown. He can then select which cardholder to issue the card. After clicking the issue card button, the application will write the cardholders selected information on the card. The standalone application was written in C# and developed using Microsoft Visual C# 2008 Express Edition. D. Standalone Application: Physicians Module Another standalone application was developed to serve the health care providers of the cardholder. This application is almost the same as the application developed for the cardholders. It allows the health care providers access to the cardholder information and it also automatically login the cardholder to the emedyx web application if they want to see the information about the cardholder that is not written in his card. This application is written also in C# and built using Microsoft Visual C# 2008 Express Edition. Instead of opening an external web browser after verifying the login information, the application opens the emedyx web application home page inside a built in web browser. A. The Web Application V. RESULTS AND DISCUSSIONS In the web application, the user will be checked upon login. The user can be identified depending on the session produced when a successful login is done. If the user is an administrator the web application will allow the user to do the following: 1) add/view/edit cardholder - When a new user is added, his data will be stored on the database to which organization he belongs. He will automatically be added to the list of cardholders of the organization and his data can be viewed and edited at the same time. All modifications done will be saved. 2) add/view/edit dependents of cardholders - When a new dependent is added, his data will be stored. He will automatically be added to the list of dependents of the cardholder and his data can be viewed and be edited at the same time. All modifications done will be saved.

4 CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 3) add/view immunization record of cardholders - When a new immunization is added, it will be stored and automatically be added to the immunization record of the cardholder. 4) add/view/edit medications of cardholders - When a new medication is added, it will be stored and automatically be added to the medications of the cardholder. This medication can be viewed and can be edited. All modifications done will be saved. Medications also includes the herbal/dietary and over the counter drugs used by the cardholder. 5) change medication status - When a list of a cardholder medication is viewed, medication status can be changed to either presently used or usage stopped. 6) add/view medical conditions of cardholders - When a new medical condition is added, it will be stored and automatically be added to the list of the cardholders medical conditions. Medical conditions also includes food, environmental, and medication allergies. 7) change medical condition status - When a list of cardholder medical condition is viewed, medical condition status can be changed either to treatment ongoing or cured. 4 Fig. 2. Above is the home page of the emedyx web application for cardholder B. The Standalone Application: Issue Card On the issue card application, all the information displayed were retrieved through web service. A list of organizations serviced by emedyx will first be retrieve from the database through web service. Depending on the organization selected, the next information that will be retrieved are the cardholders registered in the organization whom a card have not been issued yet. The last data that will be retrieved is the personal and contact information of the cardholder selected. By clicking the the issue card button, the application will connect to the card and write all the personal and contact information of the selected cardholder to the card. After writing those data to the card, another web service will be called to update the database and mark that the cardholder type as 1( card already issued ). Fig. 1. Above is the home page of the emedyx web application for the administrator On the other hand, if the user is a cardholder the web application will only allow the user to do the following: 1) view/edit his data - The cardholder can view and edit his data at the same time. All modifications done will be saved. 2) add/view/edit his dependents - When a new dependent is added, his dependent data will be stored. He will automatically be added to the list of dependents of the cardholder and his data can be viewed and be edited at the same time. All modifications done will be saved. 3) view his immunization record 4) view his medications (including his herbal/dietary and over the counter drugs) 5) view his medical conditions (including food, environmental, and medication allergies) Fig. 3. Above is the Issue Card tab of the Issue Card Application

5 CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 5 C. The Standalone Application: Connect Web On the connect web application, the cardholder will login to the web application using his card. When the Login to Web link was clicked, the cardholder id will be send to another web service that will verify if the user is a valid cardholder. If the the user is verified, a session will be inserted to the sessions table of the database and a successful message will be returned to the application. When a successful return is received, a web browser will be opened and will redirect to a page where a user session will be started. The page will then be redirected to the homepage of the emedyx web application site. Fig. 5. Above is the Physicians Module Application VI. CONCLUSION In developing the web and standalone applications, the overview of the whole system was analyzed. We used C# in the development of the standalone applications. For the development of the web application, PHP and MySQL was used. To connect the standalone applications to the web application, web services that follow SOAP format are used. Overall, the integration of the web and standalone applications was successfully done through the use of SOAP web services. VII. FOR FUTURE WORKS The study can further be improved by adding functionalities on the web application like changing the status of some medications and medical conditions. Adding some charts, images and graphs to describe a medical condition would also be a very good improvement. On the standalone applications, adding an application that will re-encrypt or re-issue a card to a cardholder would be helpful. Fig. 4. Above is the Connect Web Application D. The Standalone Application: Physicians Module On the physicians module application, the physician can initially view the information written to the cardholders card. When the View Card Information link is clicked, the application connects to the card, and retrieves the information written in it. If the View more information button is clicked, the same procedure as to connect web application will apply as to how the card will login to the web application. The emedyx web application site will be opened in a built-in web browser on C#. REFERENCES [1] biometricsdirect.com. US Biometrics and Privacy Laws & Ordinances HIPAA Compliance. [2] Wikipedia.Medical record. record [3] Wikipedia. Electronic Medical Record. medical record [4] smartocardtech.com. Smart Card Technology. [5] smartcardbasics.com. Smart Card Basics. [6] Wikipedia.Web Service. service [7] Scarfone K. Singhal A. Winograd T. (August 2007). Guide to Secure Web Services. Retrieved June 29, 2010, from [8] Suda B. (2003). SOAP Web Services. Retrieved June 29, 2010, from

6 CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE Elizabeth D. Ruetas is the eldest among the five children of Rowena and Javier Ruetas Jr.. She was born on May 26, She is a BS Computer Science undergraduate at the University of the Philippines Los Ban os and a member of The CPS Triangle, an academic organization for Computer Science, Applied Physics and Statistics. 6 1) Go to login page 2) If the user is an administrator, enter username and password. If the user is a cardholder connect to web using connect web application. 3) If the user is an administrator click login button. If the user is a cardholder verify card login information. 4) If the user is an administrator System verifies the username and password. 5) Go to Home Page A PPENDIX Use Case Diagram Everytime the user uses the software the user is required to login using his smart card or biometric profile. required always Use Case 01: Modify Profile The cardholder can modify their personal information on the PHI record but they can only view their medical information. 1) 2) 3) 4) Display PHI record. Click Profile link Display Editable Information Card holder change information that he wants to change 5) Click Save button 6) Display new PHI Record Use Case 01: Manage Dependent Information Fig. 6. usecase 01 The card holder can modify their dependent information on the PHI record. 1) Display list of dependent cardholder 2) Click the link <dependents name> or edit 3) Display the dependents PHI. 4) Display Editable Information 5) Cardholder change information that he wants to change 6) Click Save button 7) Display new Dependent Record Use Case 01: Purchase Additional Services Fig. 7. Fig. 8. usecase 02 1) Click tab Additional Services 2) Display additonal services 3) Select the services that will be purchase 4) Display a brief information about the services 5) Click purchase services button 6) Display payment transaction information 7) Fill - in payment information 8) Click Confirm Purchase 9) The services purchase are get as soon as the payment was made usecase 03 Use Case Specification Use Case 01: Login The cardholder can purchase additional services using the emedyx Web Application

7 CMSC 190 SPECIAL PROBLEM, INSTITUTE OF COMPUTER SCIENCE 7 Use Case 01: View\Print Forms The card holder can view and print forms relevant to his PHI. occasional 1) Click tab Forms 2) Display list of printable forms available to the user 3) Select form to view 4) Print form 5) Notification that improper use or storage of these forms may expose the cardholder or their dependents to an unauthorized release of their PHI will appear. 6) Cardholder approve the notification 7) The form will be printed Use Case 02: View PHI The first Responders will have the authority to view the cardholders PHI occasional 1) Display PHI record of the cardholder. Use Case 02: Change Medications The Pharmacists, ER Physicians or the patients authorized physicians have the authority to change any medications listed including dosage. occasional Use Case 03: View Record of immunization 1) Display cardholders medications 2) Click Edit Medications 3) Display editable view of the current medication 4) Edit medications 5) Click Save Changes 6) Display new medications Several institutions can have an access to the cardholders record of the immunization. If permitted by the cardholder or mandated by law. 1) Display immunization record of the cardholder.

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