Design and Validation of an Offline-First Electronic Health Record Architecture for Intermittent Connectivity Environments

Sebastian Ospina Cañari J.; del Aguila Castillo E.N.; Ricardo Hermoza Paz L. · Proceedings of the LACCEI international Multi-conference for Engineering, Education and Technology (2026) · DOI: 10.18687/laccei2026.1.1.2509

Resumen

This paper presents the design, implementation, and validation of an offline-first electronic health record (EHR) architecture intended for healthcare environments with intermittent connectivity and limited technological infrastructure. The proposed system is centered on a locally deployed architecture based on a lightweight web application with a local server, enabling the registration, storage, and management of clinical information without permanent Internet access, while incorporating deferred synchronization mechanisms aligned with HL7/FHIR-compatible structures. The validation of this architecture was carried out through the development of a functional prototype, which was evaluated under multiple operational conditions including data integrity, security, access control, synchronization behavior, and performance under load, complemented by a Technology Acceptance Model (TAM)based assessment involving 15 medical specialists to evaluate usability and adoption in real clinical contexts. Results obtained from the tested architecture demonstrate consistent data storage without record duplication, robust resistance to SQL injection attempts through parameterized queries, and reliable synchronization behavior without information loss in scenarios of intermittent connectivity, maintaining stable performance even under high-load conditions such as the registration of 1000 patients. Individual synchronization operations achieved an average latency of 5 ms, while bulk updates involving 1050 records required 91 s. The acceptance evaluation yielded mean scores above 4.0/5 across most items, lighlighting its suitability for low-connectivity environments (M=4.67) and its potential as a complementary deployment model (M=4.73). It is concluded that the validated architecture is technically viable and operationally suitable for small and medium-sized healthcare facilities, offering a practical and resilient approach for environments with constrained connectivity and infrastructure.

Instituciones: Universidad Tecnológica del Perú