LAUSR

In the Unified and Universal Health Systems of Western Europe countries and Brazil, the Electronic Health Record (EHR) is an important item within the e-health national agendas for strengthening the continuity of care in patient referral [1] and reducing patient medical error vulnerability [2]. EHR is defined as a “repository of information regarding the subject of care in machine-processable format” [3]. However, the meaning and representation of the EHR changes throughout the literature. Most of the reports deal only with disease-related EHR (ex. the diabetes card) [4] or health facility-related clinical card (ex. the hospital clinical card) [5]. Since 2006, under the mandate of the Marche Region Government, we have been developing and implementing the citizen's EHR, which is addressed far less frequently in the literature and considers at a minimum all the residents of a health district. By means of the HL7 Health Care Interoperability Standard [6], the EHR's of the 213,603 residents who live in the 1228 km of the Ascoli Piceno health district (Central Italy) were assembled by collecting and storing single citizen-related information from the records of legally validated source databases, as shown in the Fig. 1. Access to the EHR consultation occurs by logging into an individual account through the user name (the fiscal code) and password. After twenty minutes of inactivity, the log-in session expires and the user is logged out automatically. During the account subscription process, the profile of the applicant is established. In the case of citizens, the system gives permission to access only their own EHR. In the case of healthcare providers, permission is given according to the position and tasks of each individual provider, as per the databases of the human resources department of the health district secretary. To handle the EHR application smoothly, the healthcare providers were divided into different categories. In the present report, we focus only on the medical doctors of the primary and secondary levels of healthcare.