Available Issues
Authors:
| Md. Hafizur Rahman | HafizLab, Bangladesh |
https://oajea.hafizlab.com/article/01-02-005v1 
https://doi.org/10.64886/oajea.0102.005v1 
Index Terms:
Electronic health records, federated protocol, FAIR principles, interoperability, health data exchange, OAI-PMH, consent management, pseudonymisation, global patient identifier, cross-border health data exchange, national health data centreAbstract:
Electronic Health Record (EHR) exchange across heterogeneous healthcare institutions remains a persistent challenge in health informatics and biomedical engineering. Existing solutions — including IHE Cross-Enterprise Document Sharing (XDS), HL7 Direct Protocol, and FHIR Bulk Data API — each address parts of this problem but share a critical limitation: none embeds consent verification and immutable audit trail generation as first-class protocol operations. Furthermore, no globally standardised patient identifier format exists that is simultaneously unique across jurisdictions, privacy-preserving, and deployable in resource-constrained settings. This technical note introduces EHREP (Electronic Health Record Exchange Protocol), a preliminary conceptual framework for a FAIR-compliant, federated, pull-based protocol inspired by the architectural simplicity of the Open Archives Initiative Protocol for Metadata Harvesting (OAI-PMH). EHREP proposes eight protocol verbs, a consent-first data model, a pseudonymisation-by-design identity scheme, a FAIR principle compliance mapping at the protocol specification level, and a novel Global Patient Identifier (EHREP-GPID) format based on country code, identifier type, and hashed national credentials. A cross-border medical tourism scenario — illustrating how a patient treated in Bangladesh can seamlessly share clinical records with a treating physician in Thailand — is presented to demonstrate the practical applicability of the proposed framework. A national-tier extension, the National Health Data Centre (NHDC), is also proposed as a sovereign EHREP harvester node that periodically archives pseudonymised EHR records from domestic hospital nodes and serves as the authoritative cross-border query intermediary for each participating jurisdiction. This work establishes the conceptual foundation and positions EHREP as a novel contribution to the field of interoperable health information exchange, with full protocol specification, implementation, and evaluation planned as future work.Conclusion:
This technical note has introduced EHREP, a preliminary conceptual framework for a FAIR-compliant, federated, pull-based protocol for interoperable EHR exchange across heterogeneous healthcare systems. Drawing on the architectural simplicity of OAI-PMH, EHREP proposes eight protocol verbs — including ConsentVerify and AuditLog as first-class operations — a consent-first data model, a full FAIR compliance mapping at the protocol specification level, a novel EHREP-GPID format for globally unique privacy-preserving patient identification, a cross-border use case demonstrating how a patient treated in Bangladesh can seamlessly share clinical records with a treating physician in Thailand, and a proposed National Health Data Centre (NHDC) architecture as a sovereign two-tier EHR harvesting and cross-border intermediation layer. A qualitative comparison with existing mechanisms demonstrates that EHREP occupies a novel position in the design space: no existing published protocol simultaneously achieves pull-based federation, protocol-embedded consent verification, immutable audit logging, FAIR compliance, a jurisdiction-agnostic patient identifier scheme, cross-border patient continuity, and a national-tier EHR archive architecture. Future work will develop EHREP from this conceptual foundation into a formally specified, implemented, and evaluated open standard for health data exchange.License:
Articles published in OAJEA are licensed under a Creative Commons Attribution 4.0 International License.Cite This Paper:
M.H. Rahman “EHREP: A Preliminary Design Framework for a FAIR-Compliant Federated Protocol for Electronic Health Record Exchange”, Open Access Journal on Engineering Applications (OAJEA), Volume No. 01, Issue No. 02, Page 42-51, May, 2026. https://doi.org/10.64886/oajea.0102.005v1Reference:
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