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

Abstract

The digitalization of Electronic Health Records (EHRs) in healthcare facilities with intermittent connectivity remains a technical and operational challenge. This study presents the design, implementation, and validation of an offline-first EHR architecture intended for resource-limited environments. The system was developed as a lightweight web application operating on a local server, enabling clinical data registration, storage, and management without permanent Internet connectivity, and incorporating deferred synchronization mechanisms compatible with HL7/FHIR-based structures. The evaluation was conducted on a functional prototype through data integrity, security, access control, synchronization, and performance testing under load conditions, complemented by a Technology Acceptance Model (TAM)-based survey applied to 15 medical specialists. Results demonstrated consistent data storage without record duplication, resistance to SQL injection attempts through parameterized queries, automatic synchronization without data loss under intermittent connectivity, and stable response times after the mass registration of 1,000 patients. Individual record synchronization averaged 5 ms, while batch updates of 1,050 records required 91 s. User acceptance results showed mean scores above 4.0/5 across most items, particularly regarding suitability for low-connectivity settings (M=4.67) and complementary implementation potential (M=4.73). The findings indicate that the proposed architecture is technically feasible and operationally suitable for small and medium-sized healthcare facilities, providing a functional alternative for environments with connectivity and infrastructure constraints.