Abstract
Health Information Exchange (HIE) exhibits remarkable benefits for patient care such as improving healthcare quality and expediting coordinated care. The Office of the National Coordinator (ONC) for Health Information Technology is seeking patient-centric HIE designs that shift data ownership from providers to patients. There are multiple barriers to patient-centric HIE in the current system, such as security and privacy concerns, data inconsistency, timely access to the right records across multiple healthcare facilities. After investigating the current workflow of HIE, this paper provides a feasible solution to these challenges by utilizing the unique features of blockchain, a distributed ledger technology which is considered "unhackable". Utilizing the smart contract feature, which is a programmable self-executing protocol running on a blockchain, we developed a blockchain model to protect data security and patients' privacy, ensure data provenance, and provide patients full control of their health records. By personalizing data segmentation and an "allowed list" for clinicians to access their data, this design achieves patient-centric HIE. We conducted a large-scale simulation of this patient-centric HIE process and quantitatively evaluated the model's feasibility, stability, security, and robustness.
Highlights
E LECTRONIC health record (EHR) systems are widely used worldwide [1] with a more than 96% adoption rate among non-federal acute care hospitals in the USA [2]
To provide patients a robust and interoperable patient-centric Health Information Exchange (HIE) system, the existing HIE models have shown multiple challenges such as security and privacy concerns caused by central repository storage of data or patients identifiers [15], data ownership still controlled by authorities [16], mismatching of patients using record locator service (RLS) [17], and data breach caused by external cyberattacks and the threat of internal fraud [18]
Once the smart contract is deployed into the blockchain, the blockchain returns a smart-contract address and an application binary interface (ABI); this, rather than the smart-contract code or the data stored inside the smart contract, is viewable by all users
Summary
E LECTRONIC health record (EHR) systems are widely used worldwide [1] with a more than 96% adoption rate among non-federal acute care hospitals in the USA [2]. To provide patients a robust and interoperable patient-centric HIE system, the existing HIE models have shown multiple challenges such as security and privacy concerns caused by central repository storage of data or patients identifiers [15], data ownership still controlled by authorities [16], mismatching of patients using RLS [17], and data breach caused by external cyberattacks and the threat of internal fraud [18]. Emerging technologies, such as blockchain, may provide potential solutions for. There are three challenges to patient-centric exchange across institutions: (1) security and privacy concerns that may result in appalling financial and legal consequences [20]–[22]; (2) data breaches caused by unauthorized access of the patients’ health records [23]; and (3) data inconsistency between the remote provider’s EHR data and the recipient’s data [24], [25]
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