A Document-Based Electronic Health Record System Controlling the Release of Clinical Documents Using an Access Control List File Based on the HL7 Clinical Document Architecture Header

Background: Electronic health record (EHR) systems are necessary for sharing medical information between care delivery organizations (CDOs). While many standardized data can be shared, it is still difficult to share nonstandardized clinical data. Furthermore, there remains the problem that the EHR system cannot finely control the disclosure status. We have been operating a documentbased electronic medical record system called the Document Archiving and Communication System (DACS) in which printed images of all medical records are stored in PDF format. Objectives: To develop a document-based EHR system that can disclose selected clinical documents in PDF format. Methods: With a document-based EHR system, any documents stored in the DACS can be opened to a designated CDO. These open documents can be selected by the service CDO staff. In order to manage the disclosure status, an access control list (ACL) file was designed based on the HL7 clinical document architecture header. The PDF file and its ACL file were transiently stored in the Japanese standard repository, SS-MIX2. The doctor of the designated CDO was then able to access the documents according to the information in the ACL file. Results: From March 2017 to September 2017, 308 documents of 20 patients were disclosed to 3 CDOs using this document-based EHR system. These documents included examination reports, agreement forms concerning the EHR, progress notes, summaries and surgical reports generated from five different systems. Conclusions: The document-based EHR system was able to reveal clinical documents from the EMR to medical staff under a controlled disclosure environment.