Comparison of WebSocket and Hypertext Transfer Protocol for Transfer of Electronic Health Records.

Background: Electronic health records (EHR) emerged as a digital record of the data that is generated in the healthcare.
Objectives: In this paper the transfer times of EHRs using the Hypertext Transfer Protocol and WebSocket in both local network and wide area network (WAN) are compared.
Methods: A python web application to serve Fast Health Interoperability Resources (FHIR) records is created and the transfer times of the EHRs over both HTTP and WebSocket connection are measured. 45000 test Patient resources in 20, 50, 100 and 200 resources per Bundle transfers are used.
Results: WebSocket showed much better transfer times of large amount of data. These were 18 s shorter in the local network and 342 s shorter in WAN for the 20 resource per Bundle transfer.
Conclusion: RESTful APIs are a convenient way to implement EHR servers; on the other hand, HTTP becomes a bottleneck when transferring large amount of data. WebSocket shows better transfer times and thus its superiority in such situations. The problem can be addressed by developing a new communication protocol or by using network tunneling to handle large data transfer of EHRs.