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One approach to enriching the Learning Health System (LHS) is leveraging vital signs and data from wearable technologies. Blood oxygen, heart rate, respiration rates, and other data collected by wearables (like sleep and exercise patterns) can be used to monitor and predict health conditions. This data is already being collected and could be used to improve healthcare in several ways. Our approach will be health data interoperability with HL7 FHIR (for data exchange between different systems), openEHR (to store researchable data separated from software but connected to ontologies, external terminologies and code sets) and maintain the semantics of data. OpenEHR is a standard that has an important role in modelling processes and clinical decisions. The six pillars of Lifestyle Medicine can be a first attempt to change how patients see their daily decisions, affecting the mid to long-term evolution of their health. Our objective is to develop the first stage of the LHS based on a co-produced personal health recording (CoPHR) built on top of a local LLM that interoperates health data through HL7 FHIR, openEHR, OHDSI and terminologies that can ingest external evidence and produces clinical and personal decision support and, when combined with many other patients, can produce or confirm evidence.

The European Health Data Space (EHDS) proposal aims to establish a set of rules and governance frameworks to promote the use of electronic health data for both primary and secondary purposes. This study aims at analysing the implementation status of the EHDS proposal in Portugal, particularly the points concerning the primary use of health data. The proposal was scanned for the points that gave member states a direct responsibility to implement actions, and a literature review and interviews were conducted to assess the implementation status of these policies in Portugal This study found that Portugal is well advanced in the implementation of policies concerning the rights of natural persons in relation to the primary use of their personal health data, but also identified challenges, which include the lack of a common interoperability framework for the exchange of electronic health data.

The Learning Health System (LHS) is an important tool to help healthcare professionals solve problems by collecting, analyzing, interpreting and comparing health data, with the objective of helping patients make the best decision based on their own data, given the best evidence available. [1]. We believe partial oxygen saturation of arterial blood (SpO2) and related measurements and calculations can also be candidates for predictions and analysis of health conditions. We intend to build a Personal Health Record (PHR) that can exchange data with Electronic Health Records (EHRs) from hospitals, propose enhanced self-care, seek a support network, or look for healthcare assistance, (primary care or emergency service).

Since the Human Genomic Project discovered the sequencing of human genome, the interest about genome content in clinical practice has increased. Genetic information has become a key point to understand diseases or improve treatments, for example, the nutrigenomic and nutrigenetics. However, the huge amount of data generated raises the need for Electronic Health Record (EHR) improvements as it becomes increasingly necessary that it includes more specific genetic information. Thus, we aim to propose standard genetic archetypes (in openEHR) and describe our main challenges in this context. We assessed 2 bibliographical databases (Pubmed and Web of science) to determine the main clinical statements needed to create the archetypes. The clinical statements were organized in archetype-concepts, and they were created in openEHR archetype editor. One archetype - genetic test results - was created from a set of genetic data and submitted to CKM repository for review. Based on the modeled archetypes, an openEHR template can be created from the proposed archetype, mainly in the nutrigenomic area, genetic labs and others related to genetic.

Introduction The new General Data Protection Regulation (GDPR) compels health care institutions and their software providers to properly document all personal data processing and provide clear evidence that their systems are inline with the GDPR. All applications involved in personal data processing should therefore produce meaningful event logs that can later be used for the effective auditing of complex processes. Aim This paper aims to describe and evaluate HS.Register, a system created to collect and securely manage at scale audit logs and data produced by a large number of systems. Methods HS.Register creates a single audit log by collecting and aggregating all kinds of meaningful event logs and data (e.g. ActiveDirectory, syslog, log4j, web server logs, REST, SOAP and HL7 messages). It also includes specially built dashboards for easy auditing and monitoring of complex processes, crossing different systems in an integrated way, as well as providing tools for helping on the auditing and on the diagnostics of difficult problems, using a simple web application. HS.Register is currently installed at five large Portuguese Hospitals and is composed of the following open-source components: HAproxy, RabbitMQ, Elasticsearch, Logstash and Kibana. Results HS.Register currently collects and analyses an average of 93 million events per week and it is being used to document and audit HL7 communications. Discussion Auditing tools like HS.Register are likely to become mandatory in the near future to allow for traceability and detailed auditing for GDPR compliance.

The concerns about privacy and personal data protection resulted in reforms of the existing legislation in European Union (EU). The General Data Protection Regulation (GDPR) aims to reform the existing measures on the topic of personal data protection of the European Union citizens, with a strong input on the rights and freedoms of people and in the establishment of rules for the processing of personal data. OpenEHR is a standard that embodies many principles of interoperable and secure software for electronic health records. This work aims to understand to what extent the openEHR standard can be considered a solution for the requirements needed by GDPR. A list of requirements for a Hospital Information Systems (HIS) compliant with GDPR and an identification of openEHR specifications was made. The requirements were categorized and compared with the specifications. The requirements identified for the systems were matched with the openEHR specifications, which result in 16 requirements matched with openEHR. All the specifications identified matched at least one requirement. OpenEHR is a solution for the development of HIS that reinforce privacy and personal data protection, ensuring that they are contemplated in the system development. The institutions can secure that their Eletronic Health Record are compliant with GDPR while safeguarding the medical data quality and, as a result, the healthcare delivery.

With the purpose of improving the access to departmental legacy information systems, a multi agent based Virtual Electronic Patient Record (VEPR) was deployed at a major Portuguese Hospital. The agent module (MAID) is in charge of identifying new data produced (reports), collecting and making it available through an integrated web interface. The deployed MAID system uses a static interval for checking the existence of new data, however from the gathered data regarding each department data production it is observable a variable rate throughout the day. In order to address this variability an adaptive model was developed and tested in a simulated environment with real data. The model takes in consideration the past report production profiles for determining a variable query frequency in order to reduce the average time to make data available minimizing the number of departmental requests.

The transplant of cadaveric organs must be performed in a short period of time in order to achieve satisfactory results. In Hospital S. João (HSJ), a large Portuguese hospital, during 2008 and 2009, 65 and 61 respectively potential donors were identified, but 12 and 19 of them were not validated as such in time. The number of validated donors could increase if the information workflow between donor hospitals and coordinator offices became more efficient. The goal of this work is to design and implement a multi-agent software platform to assist the information workflow between donor hospitals and coordinator offices. Through several meetings with HSJ coordinator office it was characterized a set of basic data that would allow coordinator offices to early identify possible organs donors. This preliminary characterization provided the necessary grounds for the development of an agent based software application allowing the storage and management of potential donors' information and optimizing the information workflow. The information workflow and the current communication processes characterization allowed the development of a multi-agent web platform, providing a way to assist the information workflow, between coordinator hospitals and their attached hospitals network. The platform also improves direct communication between coordinator offices about most relevant facts. By using this tool or a similar one the information workflow between donor hospitals and coordinator offices can become more efficient, optimizing the pre-transplantation tasks and consequently the number of successful transplants in our country.

Although IT governance practices (like ITIL, which recommends on the use of audit logs for proper service level management) are being introduced in many Hospitals to cope with increasing levels of information quality and safety requirements, the standard maturity levels of hospital IT departments is still not enough to reach the level of frequent use of audit logs. This paper aims to address the issues related to the existence of AT in patient records, describe the Hospitals scenario and to produce recommendations. Representatives from four hospitals were interviewed regarding the use of AT in their Hospital IS. Very few AT are known to exist in these hospitals (average of 1 per hospital in an estimate of 21 existing IS). CIOs should to be much more concerned with the existence and maintenance of AT. Recommendations include server clock synchronization and using advanced log visualization tools.

Telemedicine models using commercially available technology have enabled high-quality illness care in paediatric primary care settings and markedly improved access. This fact should be explored in Pediatric Dentistry, considering that dental problems are very common in children at pre-school age and it becomes important to screen them as early as possible in order to promote the appropriate treatment. In this sense, we aim to know how telemedicine, or more specifically, teledentistry, could help on this process, evaluating the validity of children dental problems remote diagnosis based on non-invasive photographs, using accessible and low-cost technologies. Three photographs were taken for each of 66 children to be remotely analyzed by four dentists. Each dentist filled a web-based questionnaire for each child. The same children had a traditional in-person dental consultation that is used as a gold standard in this study. The results show sensitivity between 94% and 100% and specificity between 52% and 100%. The positive predictive value was between 67% and 100% and the negative predictive value between 94% and 100%. These results suggest that remote diagnosis of children dental problems based on non-invasive photographs constitute a valid resource when we pretend to exclude referred children to a dentist for treatment of dental problems, but further studies should be carried out to increase the validity of this proceeding to referring children for the same treatment.

The wider use of healthcare information systems and the easier integration and sharing of patient clinical information can facilitate a wider access to medical records. The main goal of this paper is to perform a systematic review to analyze published work that studied the impact of facilitating patients' access to their medical record. Moreover, this review includes the analysis of the potential benefits and drawbacks on patient attitudes, doctor-patient relationship and on medical practice. In order to fill a gap in terms of the electronic medical record (EMR) impact within this issue, this review will focus on the use of EMR for patients to access their medical records as well as the advantages and disadvantages that this can bring. The articles included in the study were identified using MEDLINE and Scopus databases and revised according to their title and abstract and, afterwards, their full text was read considering inclusion and exclusion criteria. From the 165 articles obtained in MEDLINE a total of 12 articles were selected. From Scopus, 2 articles were obtained, so a total of 14 articles were included in the review. The studies revealed that patients' access to medical records can be beneficial for both patients and doctors, since it enhances communication between them whilst helping patients to better understand their health condition. The drawbacks (for instance causing confusion and anxiety to patients) seem to be minimal. However, patients continue to show concerns about confidentiality and understanding what is written in their records. The studies showed that the use of EMR can bring several advantages in terms of security solutions as well as improving the correctness and completeness of the patient records.

Unlabelled: The use of communication technologies may overcome some of the difficulties of conventional, paper-based, self-management of chronic diseases. This paper aims to describe and evaluate the use of P'ASMA - a web based asthma self-management support tool regarding the opinion of patients and their adherence to monitoring in comparison to standard paper-based tools., System Description: P'ASMA allows the collection of asthma monitoring data and provides, to both patient and doctor, immediate feedback about patient's condition. For each patient a set of forms and scheduling options can be chosen., Evaluation Methods: Twenty-one adults with previous medical diagnosis of asthma were included in an exploratory randomized crossover study. Patients used P'ASMA or a paper asthma diary and action-plan each during 4 weeks in a random sequence., Results: The number of patients who wrote negative remarks regarding P'ASMA was 2 and regarding paper-tools was 11; positive comments were 6 and 1 respectively for P'ASMA and Paper-based. Twelve patients were very interested to continue to monitor their asthma using P'ASMA whereas only 2 with Paper-based (p=0.002). Of the 19 problems reported with P'ASMA, 9 were related to the Internet connection, 5 to the user interface, 3 to internal system errors and 2 to the questions interpretation. The completeness of paper diary records was better; however, 10 patients reported filling it several days at once which was not allowed in P'ASMA., Conclusions: The intervention was feasible, safe and the problems detected in the web-application can be corrected. With P'ASMA data quality improved as the integrity features increase the reliability of the data. Moreover, patients preferred the web-based application to monitor their asthma.

The Electronic Medical Record (EMR) is a very important support tool for patients and healthcare professionals but it has some barriers that prevent its successful integration within the healthcare practice. These barriers comprise not only security concerns but also costs, in terms of time and effort, as well as relational and educational issues that can hinder its proper use. Access control is an essential part of the EMR and provides for its confidentiality by checking if a user has the necessary rights to access the resources he/she requested. This paper comprehensively reviews the published material about access control in healthcare. The review reveals that most of the access control systems that are published in the literature are just studies or prototypes in which healthcare professionals and patients did not participate in the definition of the access control policies, models or mechanisms. Healthcare professionals usually needed to change their workflow patterns and adapt their tasks and processes in order to use the systems. If access control could be improved according to the users' needs and be properly adapted to their workflow patterns we hypothesise that some of the barriers to the effective use of EMR could be reduced. Then EMR could be more successfully integrated into the healthcare practice and provide for better patient treatment.

The main objective of the Introduction to Medicine (IM) subject of the first year of the Medical Course at the Faculty of Medicine of the University of Porto is to provide students with a first contact with the areas of Biostatistics, Medical Informatics, Bioethics and the History of Medicine in the belief that they will be better prepared to learn, research, evaluate, share and decide within their practice. This paper presents a case study that describes how the subject IM is organized and how the b-learning tool (Moodle) is used to correct and grade the students' work. From the 239 students registered to attend the Introduction to Medicine subject 12% failed. The average grade among the successful students was 16 (out of 20). In the previous academic year only 2% of the students failed. However, among the successful students, the average grade was inferior (15 out of 20). The e-learning model that was described in this paper was successful because the results show that the students that made use of the Moodle got better grades.

Integration of hospital departmental information systems (HDIS) has become a common but difficult issue. In May 2003, the Department of Biostatistics and Medical Informatics implemented a Virtual Electronic Patient Record (VEPR) for the Hospital S. João (HSJ), a university hospital with over 1350 beds. The system integrates clinical data from 10 legacy HDIS plus the Hospital Administrative Database (HAD), aiming to deliver all patient information to health professionals. Currently, around 500 medical doctors use the system on a regular basis and the HSJ-VEPR retrieves an average of 3,000 new reports per day, in PDF or HTML formats. This paper describes and discusses the role of monitoring in the assurance and improvement of data quality. Three approaches were put in place: (a) monitoring the HSJ-VEPR concerning the frequency of clinical records retrieved from the DIS by checking if the daily number of reports sent by the HDIS fell in the normal range from similar week days; (b) monitoring inconsistencies in the patient's identification by cross-checking between HDIS and HAD; and (c) monitoring the integrity of clinical records delivered to medical doctors through the HSJ-VEPR by checking their digital signature. During 2005, the monitoring system detected 53 unusual frequency patterns of which 44 corresponded to real problems. Over a 6 months period, more than 400 alerts were generated concerning inconsistencies in the patient's identification found in laboratory reports. Nevertheless, a significant reduction in the number of these inconsistencies occurred - from 116 in July to 10 in December 2005--due to implementation of preventive measures by the DIS. Finally, report's integrity was checked each time the report was asked to be visualized i.e. in more than one hundred thousand times during a one year period. In conclusion, all information available in hospital information systems can and should be used to trigger alerts of malfunctions and inconsistencies, in order to improve data quality and ensure a better health care.