Why Blockchain for Healthcare?
In addition to high administration costs and inefficiency long attributed
to health care systems, traditional electronic health records (EHR)
implemented using legacy database systems suffer intrinsically from issues around:
- Ownership & Accessibility – Patients have no control over where their records reside and who is allowed to access them.
- Data Governance – With multiple copies of the records residing in multiple databases, there lacks one consistent version of the truth.
- Interoperability – Traditional EHR data is trapped in different record-keeping systems that may or may not be compatible with each other.
- Compliance – Not all EHR formats meet all compliance regulations in different jurisdictions.
- Security – Traditional database and access security issues are compounded by the distribution of EHR across multiple platforms.
The immutability and transparency of blockchain technology makes it
the natural enabler of revolutionary innovations in health tech. The
technology is uniquely suited to power a patient-centric, peer-managed,
secured and accessible chronological database across multiple devices,
enabling patient service models previously deemed impossible.
Jonah's MediBlock - EHR Blockchain PoC
From ambitious projects like establishing a dedicated chain to house its
citizens’ health records in Estonia, to startups tackling specific
challenges in the healthcare industry with blockchain, these initiatives
showcase one common attribute of the technology. They demonstrate how
the immutable nature of blockchain could be leveraged to establish
transactional trust across multiple parties, share data and transact
business. These initiatives aim at elevating the quality of care to the
patients and improving overall accountability and efficiency of
health management systems – all the while establishing the relevance of
blockchain in the healthcare sector.
With Jonah’s long-standing history in the health insurance and health
management verticals, we see a unique role in this technological
revolution for us. We help our customers apply blockchain solutions to
solve business challenges where appropriate while remaining
agnostic to the technology stack. We examine each challenge from a
business perspective and gauge the merits of technological components
accordingly on a case-by-case basis.
Medical Blockchain - Proof of Concept
Empowering patients with granular and decentralized control of their EHR
(Electronic Health Record) remains one of the most prominent challenges
in the field of healthcare. With EHR’s scattered across disparate
databases in multiple hospitals, laboratories and clinics, not only is
it difficult for patients to control who has access to which portions of
their records, the lack of data governance often makes it difficult to
establish one common version of the truth.
Immutability, non-repudiation, integrity, transparency and equal-rights,
the five properties of the blockchain technology allow the healthcare
blockchain participants to rely on the technology to facilitate the
transactions, severing their dependence on third-party organizations. As
such, instead of automatically ceding control of their entire medical history to healthcare providers through implicit trust, the patients can retain full control and selectively grant access to specific parts of their records.
This POC (Proof of Concept) examines one specific challenge: how to
enable patient and practitioner access to EHR's in a decentralized solution. For the purpose of this POC, patient information was considered
available through a FHIR (Fast Healthcare Information Resource) interface, imposing no requirement that the data live either on- or off-chain. This arrangement allows us to focus on our main objective
without delving into the issue of data availability and format.
To address patient privacy issues, not only does every user need to be
registered, each access must be identified. As such, a "permissioned"
blockchain was used - implemented on Hyperledger technologies. However, this POC is technology agnostic. Other permissioned (or "private") blockchain platforms could potentially be used instead.
Furthermore, we adopted the Hyperledger Composer development thought
process - defining a blockchain business model first, before diving
into the technical details.
Hyperledger Composer, built on Hyperledger Fabric, accelerates the
process of turning business models into software. Composer provides a DSL
(Domain Specific Language) to model business assets, define access
control and build a business network. By using Composer, the business
model can be validated through a browser without setting up any
infrastructure. However, the Composer itself isn’t a blockchain — there is
still the need to deploy Composer applications onto a Fabric instance.
Next, a realistic EHR model was developed, consisting of the
Particpant roles of
Fundamental to this model, a Patient has the right to grant Practitioner
and Third Party limited and temporary access to their EHR. The use
case of Third Parties acting as a proxy for Patient to manage their EHR
reflect real-world scenarios such as parents granting power of attorney to their children to manage their medical affairs. However, this POC remains focused on a direct Patient-Practitioner relationship, as the Third Party use case does not require much more technically.
Another component within the EHR model are the Asset classes:
PatientInfo represents protected resources: the focal point of the blockchain. This asset is designed to be a container of all patient's EHR data, which can be persisted with on-chain, off-chain storage, or a combination of both. The
PatientInfoAccess asset is the contract between a
Patient and a
Practitioner, established for the duration of a discrete healthcare service. The EHR access enforces an expiry date on the granted access to protected EHR resources, such as visit, observation and medication records, etc.
This business model defines:
Figure 1. MediBlock PoC - modeling with the Hyperledger Composer business
The EHR access has an expiry date. The
Medication are stored on-chain in the
PatientInfo as the protected
resources. The patient has full-control over who and how these
resources can be used. For the external system to interact with the
blockchain, a set of transactions, e.g.
UpdateMedication, are defined.
Patient and Practitioner Interaction Scenario
For the PoC, we have modeled the scenario for a
Patient visiting a
Practitioner. Initially, the
Practitioner does not have access to the
PatientInfo. To grant the Practitioner access,
the QR code of the
Practitioner credential (left image below), toggles
the access permissions on the screen, and commits a
transaction to establish a time-limited access to the
(middle image below) for the Practitioner.
Figure 2. MediBlock PoC UI Screens - (left) UI shows the practitioner's QR
code to be scanned by the patient. (middle) UI shows the practitioner’s access controlled by the patient. (right) UI shows the patient's EHR
visible to the practitioner; only seeing Rx medications is granted in
Practitioner can see the permitted
PatientInfo for the
current visit's diagnosis (right image above). After the visit,
Practitioner submits a new
Visit transaction to the
PatientInfo to record the event. The
Patient can view his/her
PatientInfo anytime after the visit.
The following sequence diagram depicts the described scenario,
illustrating the interaction with the blockchain.
Figure 3. MediBlock PoC Workflow - the UML sequence diagram shows the
high-level interaction between the actors and the blockchain,
interfacing with the patient EHR records.
To add realism to the interactions amongst the parties, a mobile UI was
developed for both the
Practitioner personas. This provided a practical demonstration of the effectiveness and granularity of access control. Transaction records of these interactions are permanently registered into the blockchain, for access at any time.
What We Learned
In our previous blockchain outings we have concluded that blockchain
technology is at its most effective and impactful when its inherent
characteristics uniquely address key business challenges. The MediBlock
POC affirmed that judicious application of the blockchain technology
could bring immense payoff in the healthcare vertical. In this case, the
new immutable data capabilities of Hyperledger Fabric was used to enable a range of innovative solutions, validating how blockchain could be vital to the future of health-tech.
It is evident that the health-tech industry recognizes the unusual
opportunities presented by the blockchain technology given the level of
investment and activity. While the governing bodies are trying to
navigate this revolution, the industry is taking the lead and making significant headway. At Jonah we will continue to apply our blockchain know-how to identity, privacy and other health-tech initiatives, contributing to the ever-expanding blockchain knowledge pool.
Blockchain is not a solution in search of a problem nor is it the
panacea to all business challenges. Talk to us, let us help you
determine if blockchain holds the key to your business solutions.