One of the issues with modern Electronic Medical Records (EHR) is the inability to interoperate. HL7 standards organization has provided protocols for transmitting the information, however that is only a small part of the problem. Issue such as provenance, Digital Signing, content management, identity and encryption to name a few, inhibit easy sharing of data. There is now a technology that could eliminate the majority of these issues and provide us with the promise of a Cradle-to-Grave EHR, that is Blockchain.
Blockchain is the OpenSource technology that support the somewhat infamous Bitcoin. Regardless of your opinion of Bitcoin, Blockchain technology is a very viable open distributive ledger solution. Blockchain provide a P2P (point to point) encrypted realtime mesh network, where transactions are timestamped and verified on an open ledger system. Consensus is the system used to validate the integrity of a message or document, each time a document is altered, a new block is added to the chain providing a linear and reproducible record of access and updates via a hashing function.
I mentioned "without disruption" in the title because, health organizations have suffered a lot of disruption in the last few years with the advent of the EHR requirements. I believe there is a better way to design, using an adjunct processor solution, i.e., by providing interfaces to the EHR via HL7 FHIR and providing a Blockchain API, the EHR can use a Blockchain without significantly disrupting their EHR installation.
To answer the question of the Blockchain records, there are many solutions already available for storing records on open Blockchain, the Bitcoin chain. however, even thought blocks do not contain readable data, it may be optimal to store the records on private Permission networks, such as hospital networks and validate via consensus process or Paxos, such as, Practical Byzantine Fault tolerance used by Hyperledger,
The following are some of the feature that would be provided to a medical record using Blockchain:
- Data Provenance
- Non-repudiation
- Digital Signing of charts/records
- Linear chronological tracking, Audits records
- PKI cryptography/encryption
- Distributed decentralized, encrypted P2P messaging network
- Identity management
- OpenSource
- Ubiquitous sharing of data
- No Single Point of Failure
- Realtime transaction
- Content Management
- Public Records - Birth to Death longitudinal record
- Uses ‘Proof-of-Work’ technology
- time-stamping
- Private or public chains
- Distributed databases
