Introduction: As medical care gets more and more complex and new information is already overwhelming physician‘s capacity to treat patients with the latest information, physicians need new technologies to help them cope. There is great need for a digital record to allow capture of patient data that can then be processed and mined for insights into better treatment for patients. The electronic medical record (EMR) is the tool that promises to provide the platform from which new functionality and new services can be provided for patients.

History of Electronic Medical Records: Documentation is required as an archival record of what happened in cases of dispute. To a great extent, physicians resent the task of documentation, as it detracts from their primary task: taking care of patients. Communication between practitioners is difficult as in many cases the information collected is fragmented, frequently redundant and voluminous. Finally, physicians are constantly inundated with new information and have no tools to help them incorporate new techniques and treatments into their day-to-day activities, other than using their memories or having to lug around large textbooks.

The idea of recording patient information electronically instead of on paper –the Electronic Medical Record (EMR) –has been around since the late 1960‘s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice. Until then, doctor‘s usually recorded only their diagnoses and the treatment they provided. Weed‘s innovation was to generate a record that would allow a third party to independently verify the diagnosis. In 1972, the Regenstreif Institute developed the first medical records system.

However, in spite of pockets of use of EMR since the 1970‘s, mostly in government hospitals and a few visionary health institutions, EMR use has not taken off. The vast majority of physicians work in 1-3 physician practices, where the costs of implementing technology are prohibitive.

Performance criteria:

Physicians need to able to document findings and look up information quickly and easily in their electronic medical record. Since most patient encounters last about 7-10 minutes and typically 25% of the time is spent in documentation, physicians need to be able to record an encounter in about 2 minutes. They need systems that are low in cost to purchase and to maintain; they need highly reliable systems which are always available, that are easy to support and protected from data loss. They need systems which are easy to use and which don‘t require long learning curves. They also want systems which enable them to control where and how the information they collect is used, as they need to promise confidentiality to their patients.

In addition to physicians, health care systems (e.g., HMOs, Regional Health Authorities, Ministries of Health) also need information technology to meet their management and administration needs. Their performance criteria include timely reporting of data, reduction of duplicate tests, reduction of medical errors, improvement of care and cost management. There has been an on-going tension in the health care marketplace between the needs of physicians and healthcare systems –their needs have not always been aligned. Additional performance criteria include use of standards for data exchange, billing, diagnosis, medications and laboratory data. To distinguish technology that meets health system needs from technology that meets physician needs, we will introduce a new term: Electronic Health Record (EHR). The EHR is the system that attempts to meet health system needs.

Although many people in the industry claim that no new technology is required to make the EMR effective in clinical practice, the infrastructure for exchanging data between physicians and pharmacists or laboratory technicians (the EHR) is still not in place.

Description of the technology: Clearly, the EMR (used by physicians in their offices) and the EHR (used by health systems to transmit and manage health care data) are complementary technologies. The modules required by an EMR include: scheduling, patient registration, documenting patient encounters, writing prescriptions, managing documents, requisitioning and receiving lab and diagnostic imaging reports, managing interoffice communications, clinical decision support and billing. The modules required by an EHR are: authentication of patients and providers, laboratory results reporting, drug claims adjudication, diagnostic imaging reporting, hospital discharge summaries, secure messaging and clinical decision support [1].

The key platforms that have had some success are the VistA program developed by/for the Veteran‘s Affair‘s Hospital system in the US. The first EMRs were large repositories with different views for different clinicians. Increasingly, new EMRs are being defined as modular components: the Good Electronic Health Record project, the OpenEHR project and the Canada Health Infoway EHR Blueprint are all very modular intheir approach.

In the last few years, governments around the world and health maintenance organizations (HMOs) in the US are increasingly encouraging the implementation of EMRs. Many western European countries have subsidized the cost of EMR so that physicians can afford them. In some European countries as many as 80-90% of physicians use an EMR in their practice. In these countries, governments have realized that EHRs cannot work if physicians are not using EMRs, since a crucial component of data is not available.

The major barriers to widespread EMR implementation are cost (both direct and indirect) and time required for documentation –current methods of data input are slow and tedious.2 If discontinuities are going to make a difference to EMR uptake, it will have to be in these two areas. A data input breakthrough in the computer area in general could make a huge impact in this arena.

Forecasting the future of EMRs. Forecasting the future of EMRs is extremely difficult. Although there are some time series data available for this market place, the data mixes EHR and EMR components as the market suppliers do not make a distinction between physician needs and health care system needs. Although we expect that the two markets are likely to move hand-in-hand, they are different and distinct markets. The cumulative number of installs has been growing steadily since 1998 and the post Y2K incremental growth rate for this market is around 15-25% annually [1].

In fact, a recent study has shown that the major customers for EMRs will not be physicians as they are only small beneficiaries of these systems. Wang et al have estimated that a health care system that implements an EMR will stand to benefit, on average, $86,000 US over 3 years. This figure represents savings from prevention of medication errors, decreased utilization of laboratory testing and improved billing capture.

Rather than provide some sort of quantitative model for how the EMR industry will unfold –which would be meaningless in this context –we will provide some potential scenarios, looking at major determinants of whether or not the technology will diffuse into the medical sector. There are several barriers to widespread EMR implementation: 1) Total Cost of Ownership (TCO), 2) Speed of data input, 3) Inability to grow the top-line to recoup IT investments.

The major determinant of diffusion of computers into physician offices in most countries in the world has been the existence of subsidies [1].

It is unlikely that a breakthrough in data input technology, by itself, would lead physicians to embrace the technology. Some physicians who use current technology claim that they are able to see more patients after implementing an EMR. They claim that the additional patients they are able to see justifiy the cost of implementing the EMR. However, not all physicians who have implemented EMR have experienced this and most physicians feel that they see enough patients and why would they want to see more just so they can have an EMR!

Conclusion: EMR technology has been around for a long time and has not taken off in the market place. This technology is very dependent on innovations and breakthroughs that occur outside of the health care space. The dominant design paradigm does not appear to hold for core health care applications in the EMR, even though it does hold for many parts of the EMR because the EMR depends on the general information technology marketplace for many of its components. It appears that the Modularization of Design paradigm explains developments in the area better than the Dominant Design paradigm. There do not appear to be any increasing returns or lock-ins from standards, as standards are increasingly determined through consensus processes in the industry. There are many Open Source EMRs freely available. All the above leads us to conclude that this marketplace has a weak appropriability regime and that having and wielding specialized complementary assets is likely to be a major determinant of competitive advantage.

Finally, we conclude that there is only one major obstacle to widespread EMR uptake: the high total cost of ownership. If this can be brought down, either through subsidies or through technological breakthroughs, then we will see EMR uptake at a relatively rapid pace. However, if the cost cannot be brought down, then, even if other major problems are resolved, we should not expect that the market place would take off quickly.

Text 2

Lip motion password: Scientists develop hackproof identity authentication via lips for enhanced security

by Sekhar Maddala. Retrieved December 5, 2017 from

http://www.chaprama.com/2017/03/lip-motion-password-hackproof-identity-authentication

In everyday life, we often face the situation when many services and devices ask us to confirm our identity using a password. Secrecy methods based on symbolic passwords have a number of drawbacks: they must be complex enough to provide the required level of cryptographic stability, users tend to forget them, passwords can be compromised, etc. More promising direction of information security is sure to be such technologies for providing password protection which use biometric information. Now biometric passwords are found in mobile devices in the form of a fingerprint sensor. Voice assistants such as Alexa from Amazon or Siri can analyze the voice of their owner and use it as an identity card [1]. However, biometric information for identification of a person extends much further.

Biometric data is known to be used all over the world: for instance, fingerprints for unlocking mobile devices and checking identity on immigration and customs counters. Despite widespread use, it is impossible to change the scanning of their fingerprint. After scanning or hacking the scan, the owner cannot change his fingerprints and must search for another personal data protection system. In this regard, a scientist from the HKBU invented a new technology called the "lip-movement password" (the password for the lips), which uses the movements of the person's lips to create a password. This system checks the identity of a person by simultaneously comparing the contents of the password with the basic behavioral characteristics of the movement of the lips. No one can mimic the movement of the user's lips when pronouncing a password, which can be changed at any time. This is really new technology, the first in the world and received a US patent in 2015, is expected to be used to authenticate financial transactions. The present article is aimed to analyze this cutting-edge technology in more detail.

The Department of Computer Science of HKBU, Professor Cheung Jiu-ming, responsible for the study, said that the new technique has several advantages over conventional access control methods:

1) the dynamic characteristics of lip movements are resistant to mimicry, so the lip password can be used separately for verifying speakers because it is able to detect and reject an incorrect password pronounced by the user, or the correct password that the imposter speaks;

2) a check based on a combination of lip movements and password content ensures that access control is doubly safe;

3) compared with traditional voice authentication, the acquisition and analysis of lip movements are less susceptible to background noise and distance; moreover, it can even be used by a person with speech deficiencies;

4) the user can reset his or her password in a timely manner in order to enhance safety;

5) there is no language border, in other words, a person from any country can use this system to verify the user's password.

It is worth noticing the opinion of professor Chung, that the same password that two people speak is different, and the learning system can distinguish them [2]. The study adopted a model of computational learning that extracts visual characteristics of the shape of the lips, texture and movement to characterize the consistency of the lips. Samples of the lip sequence are collected and analyzed for training models and determining the threshold for accepting and rejecting the conversation password.

Potential application of this new patented technology includes, but is not limited to, authentication of financial transactions, including electronic payments using mobile devices, ATM transactions and credit card user passwords. It can also be applied to improve the access control system to the security system, which is currently used in the entrances of companies or private premises [3].

Like other biometric technologies, the system must undergo a learning phase, requiring users to repeat the phrase 10 times to recognize the consistency of the lips. This allows the system to create a threshold value for accepting or rejecting a phrase. Every time the phrase is repeated, there must be some small differences in it. Chung said that everyone had his own lip sequence, which meant that the importers would be checked. An imposter who reads the same phrase will still be rejected by the system.

The software is still at the prototype stage, and there is no time frame when it can be used commercially. Cheng acknowledged that there are areas for work, for example, how reliability affects the brightness of the environment. In general, the accuracy is about 90 percent [1]. He also did not decide whether it was possible to deceive the system by showing a videotape of lip reading on the screen, emphasizing that this technology is not mutually exclusive with other authentication systems. He expressed hope that this will be achieved within a year.

In addition, the lip password can be used together with other biometric data to improve the security of the systems. For example, the password for the lips can be combined with face recognition, as a result of which the problem of changing faces will be solved by recognizing 3D masks when checking the personality.

Text 3

Nakamoto, S. (n.d.). Bitcoin: A Peer-to-Peer Electronic Cash System. Retrieved March 03, 2017 from https://bitcoin.org/bitcoin.pdf