Efficient Health Information Exchange Automation System Based on Blockchain and IPFS

Behavioral Health Data in the Electronic Health Record: Privacy Concerns Slow Sharing

The movement to establish widespread health information exchange (HIE) in the U.S. has thus far shown mixed results. Even long-standing and eminently successful HIEs have been slow to gather clinical data from independent office-based practices, [2] which account for the majority of healthcare utilization in the U.S.[3] Nor is much known about the extent to which existing HIEs organize clinical data as patientcentric, longitudinal records, accessible to all providers caring for a patient. Many HIEs achieve sustainability by automating the delivery of test results,[1] rather than by offering more robust data exchange functionality in which providers can actually view a wide array of clinical data generated by other providers, formatted as a unified record for each patient. Understanding why providers, especially those who are office-based, do or do not participate in HIE has become even more urgent now, to inform how ARRA's payments for meaningful use of HIE can be effectively targeted.

BackgroundBlockchain has the potential to disrupt the current modes of patient data access, accumulation, contribution, exchange, and control. Using interoperability standards, smart contracts, and cryptographic identities, patients can securely exchange data with providers and regulate access. The resulting comprehensive, longitudinal medical records can significantly improve the cost and quality of patient care for individuals and populations alike.ObjectiveThis work presents HealthChain, a novel patient-centered blockchain framework. The intent is to bolster patient engagement, data curation, and regulated dissemination of accumulated information in a secure, interoperable environment. A mixed-block blockchain is proposed to support immutable logging and redactable patient blocks. Patient data are generated and exchanged through Health Level-7 Fast Healthcare Interoperability Resources, allowing seamless transfer with compliant systems. In addition, patients receive cryptographic identities in the form of public and private key pairs. Public keys are stored in the blockchain and are suitable for securing and verifying transactions. Furthermore, the envisaged system uses proxy re-encryption (PRE) to share information through revocable, smart contracts, ensuring the preservation of privacy and confidentiality. Finally, several PRE improvements are offered to enhance performance and security.MethodsThe framework was formulated to address key barriers to blockchain adoption in health care, namely, information security, interoperability, data integrity, identity validation, and scalability. It supports 16 configurations through the manipulation of 4 modes. An open-source, proof-of-concept tool was developed to evaluate the performance of the novel patient block components and system configurations. To demonstrate the utility of the proposed framework and evaluate resource consumption, extensive testing was performed on each of the 16 configurations over a variety of scenarios involving a variable number of existing and imported records.ResultsThe results indicate several clear high-performing, low-bandwidth configurations, although they are not the strongest cryptographically. Of the strongest models, one’s anticipated cumulative record size is shown to influence the selection. Although the most efficient algorithm is ultimately user specific, Advanced Encryption Standard–encrypted data with static keys, incremental server storage, and no additional server-side encryption are the fastest and least bandwidth intensive, whereas proxy re-encrypted data with dynamic keys, incremental server storage, and additional server-side encryption are the best performing of the strongest configurations.ConclusionsBlockchain is a potent and viable technology for patient-centered access to and exchange of health information. By integrating a structured, interoperable design with patient-accumulated and generated data shared through smart contracts into a universally accessible blockchain, HealthChain presents patients and providers with access to consistent and comprehensive medical records. Challenges addressed include data security, interoperability, block storage, and patient-administered data access, with several configurations emerging for further consideration regarding speed and security.

Unfulfilled promises of health information exchange: What inhibits ambulatory clinics from electronically sharing health information?

Comparison of consumers’ perspectives on different health information exchange (HIE) mechanisms: an experimental study

Health information exchanges have been popular for some time with their advantages known and widely researched. In spite of their utility in increasing provider efficiency and decreasing administrative costs, one challenge that has persisted is the data owners inability to control data after transmission. The lack of technical mechanisms to effectively control patients’ health data in the network significantly affects participation of health and medical institutions while perpetrating the silo-based data management that locks value and potential inherent in the data. This not only affects researchers due to the lack of data for research and analysis but the quality of life of patients.We present a blockchain-supported architectural framework for secure control of personal data in a health information exchange by pairing user-generated acceptable use policies with smart contracts. We highlight the merits of our system, its user-centric focus and also show experimental results along with directions for extending our work. The framework introduces minimal risk to data by architecting a mechanism for controlling data after sharing. In adopting our framework, health service providers can deliver a stronger assurance for data management than is possible with current systems.

Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain

The Trials and Tribulations of Health Information Sharing: The Turbulent Rise of the Rhio

Ethereum is a decentralized blockchain technology equipped with so-called Smart Contracts. A contract is a program whose code is public, which can be triggered by any user, and whose actual execution is performed by miners participating in Ethereum. Miners execute the contract on the Ethereum Virtual Machine (EVM) and apply its effect by adding new blocks to the blockchain. A contract that takes too much time to be processed by the miners of the network may result into delays or a denial of service in the Ethereum system. To prevent this scenario, termination of Ethereum's Smart Contracts is ensured using a gas mechanism. Roughly, the EVM consumes gas to process each instruction of a contract and the gas provided to run a contract is limited. This technique could make termination of contracts easy to prove but the way the official definition of the EVM specifies gas usage makes the proof of this property non-trivial. EVM implementations and formal analysis techniques of EVM's Smart Contracts use termination of contracts as an assumption, so having a formal proof of termination of contracts is crucial. This paper presents a mechanized, formal, and general proof of termination of Smart Contracts based on a measure of EVM call stacks.

The 2009 Health Information Technology for Economic and Clinical Health Act sets three stages of Meaningful Use requirements for the electronic health records incentive program. Health information exchange (HIE) technologies are critical in the meaningful use of electronic health records to support patient care coordination. However, HIE use trends and barriers remain unclear across hospitals in South Carolina (SC), a state with the earliest HIE implementation. This study aims to explore changes in the proportion of HIE participation and factors associated with HIE participation, and barriers to exchange and interoperability across SC hospitals. This study derived data from a longitudinal data set of the 2014-2020 American Hospital Association Information Technology Supplement for 69 SC hospitals. The primary outcome was whether a hospital participated in HIE in a year. A cross-sectional multivariable logistic regression model, clustered at the hospital level and weighted by bed size, was used to identify factors associated with HIE participation. The second outcome was barriers to sending, receiving, or finding patient health information to or from other organizations or hospital systems. The frequency of hospitals reporting each barrier related to exchange and interoperability were then calculated. Hospitals in SC have been increasingly participating in HIE, improving from 43% (24/56) in 2014 to 82% (54/66) in 2020. After controlling for other hospital factors, teaching hospitals (adjusted odds ratio [AOR] 3.7, 95% CI 1.0-13.3), system-affiliated hospitals (AOR 6.6, 95% CI 3.2-13.7), and rural referral hospitals (AOR 8.0, 95% CI 1.2-53.4) had higher odds to participate in HIE than their counterparts, whereas critical access hospitals (AOR 0.1, 95% CI 0.02-0.6) were less likely to participate in HIE than their counterparts reimbursed by the prospective payment system. Hospitals with greater ratios of Medicare or Medicaid inpatient days to total inpatient days also reported higher odds of HIE participation. Despite the majority of hospitals reporting HIE participation in 2020, barriers to exchange and interoperability remained, including lack of provider contacts (27/40, 68%), difficulty in finding patient health information (27/40, 68%), adapting different vendor platforms (26/40, 65%), difficulty matching or identifying same patients between systems (23/40, 58%), and providers that do not typically exchange patient data (23/40, 58%). HIE participation has been widely adopted in SC hospitals. Our findings highlight the need to incentivize optimization of HIE and seamless information exchange by facilitating and implementing standardization of health information across various HIE systems and by addressing other technical issues, including providing providers' addresses and training HIE stakeholders to find relevant information. Policies and efforts should include more collaboration with vendors to reduce platform compatibility issues and more user engagement and technical training and support to facilitate effective, accurate, and efficient exchange of provider contacts and patient health information.

Chapter 2 - Health information exchange as a profession

ObjectiveTo characterize state and local health agency relationships with health information exchange organizations.IntroductionThere is growing interest in leveraging available health information exchange (HIE) infrastructures to improve public health surveillance (1). The Health Information Technology for Clinical and Economic Health Act and Meaningful Use criteria for electronic health record (EHR) systems are among the factors driving the development, adoption and use of HIEs. HIEs deliver or make accessible clinical and administrative data as patients are admitted, discharged, and transferred across hospitals, clinics, medical centers, counties, states and regions (2). While several HIE infrastructures exist (3), there is little evidence on the engagement in HIE initiatives by state and local health agencies.MethodsAn online survey of state and local health officials was conducted in six states where HIEs were known to be present. Half of the states were funded by the Centers for Disease Control and Prevention (CDC) to engage public health agencies in HIE activities; the other half received no such funding. A total of 143 officials were invited to participate; 73 (51%) responded. The survey asked respondents about their agencies awareness, engagement, and data exchange with HIEs. The survey further asked agencies about their perceptions of barriers and challenges to public health engagement with HIE organizations.ResultsJust 25% of agencies had a formal relationship, typically created through a memorandum of understanding or data usage agreement, with at least one nearby HIE. The majority (54%) of agencies either had no relationship (20%) or only an informal relationship (34%) with an HIE. The remaining agencies (18%) reported that no HIE existed in their jurisdiction. Agencies in states that had received CDC funding for HIE engagement were more likely (14 versus 2) to be formally partnered with an HIE.ConclusionsFew public health agencies are formally engaged in HIE. Financial costs, human resources, and concerns regarding privacy/security were the top cited barriers to broader engagement in HIE. For public health to be an active participant in and reap the benefits of HIE, greater investment in state and local public health informatics capacity, including human resources, and education regarding HIE privacy and security practices are needed.

BackgroundIn the context of exchange technologies, such as health information exchange (HIE), existing technology acceptance theories should be expanded to consider not only the cognitive beliefs resulting in adoption behavior but also the affect provoked by the sharing nature of the technology.ObjectiveWe aimed to study HIE adoption using a trust-centered model. Based on the Theory of Reasoned Action, the technology adoption literature, and the trust transfer mechanism, we theoretically explained and empirically tested the impacts of the perceived transparency of privacy policy and trust in health care providers on cognitive and emotional trust in an HIE. Moreover, we analyzed the effects of cognitive and emotional trust on the intention to opt in to the HIE and willingness to disclose health information.MethodsA Web-based survey was conducted using data from a sample of 493 individuals who were aware of the HIE through experiences with a (or multiple) provider(s) participating in an HIE network.ResultsStructural Equation Modeling analysis results provided empirical support for the proposed model. Our findings indicated that when patients trust in health care providers, and they are aware of HIE security measures, HIE sharing procedures, and privacy terms, they feel more in control, more assured, and less at risk. Moreover, trust in providers has a significant moderating effect on building trust in HIE efforts (P<.05). Results also showed that patient trust in HIE may take the forms of opt-in intentions to HIE and patients’ willingness to disclose health information that are exchanged through the HIE (P<.001).ConclusionsThe results of this research should be of interest to both academics and practitioners. The findings provide an in-depth dimension of the HIE privacy policy that should be addressed by the health care organizations to exchange personal health information in a secure and private manner. This study can contribute to trust transfer theory and enrich the literature on HIE efforts. Primary and secondary care providers can also identify how to leverage the benefit of patients’ trust and trust transfer process to promote HIE initiatives nationwide.

Health information exchange (HIE) describes both (1) the act of sharing of clinical and administrative health care data between interested stakeholders and (2) the actual health information technologies and systems that facilitate this sharing. There have been multiple iterations of this concept over the past three decades, starting with the Community Health Information Networks of the 1980s, the Regional Health Information Organizations of the late 1990s - early 2000s, and now the health information exchanges that exist in various forms and offer services ranging from basic connectivity to more advanced functions such as master patient indexes, provider directories, trust services, e-prescribing, and public health reporting. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has helped to promote HIE by including HIE reporting as a Meaningful Use Stage 2 measure and funding the State HIE Cooperative Agreement Program which provides funding for a state designated entity (SDE) to plan and build HIE capacity. There are many challenges to address. Data and messaging standards are required for semantic interoperability. The complexity of information privacy and security policies and regulations increases proportionately with the number of HIE participants. Governance and sustainability are also major challenges that must be met. The future of HIE is promising. The increasing adoption of EHR systems creates a pool of electronic health data that can support public health needs, such as automated reporting for communicable diseases, predictive analysis for syndromic surveillance, and population health reporting.KeywordsSynchronousAsynchronousVerticalHorizontalDiagonalHealth information exchangeCommunity health information networkRegional health information organizationNationwide Health Information NetworkInteroperabilityGovernancePrivacySecurityMeaningful useInformation models

Academic publishing repositories in developing nations often face severe challenges in enforcing secure and transparent access control, exacerbated by centralized authority, weak audit trails, and data manipulation risks. This research proposes a decentralized access control system using Hyperledger Fabric blockchain and smart contracts to ensure secure, transparent, and tamper-proof data access in academic repositories. Using a constructive research methodology, the study develops and evaluates a blockchain-integrated framework tailored for repositories like DSpace. The methodology includes model-driven engineering, smart contract development in GoLang, PKI-based identity control, and simulation via Dockerized microservices. Empirical evaluation reveals superior performance: 250ms transaction latency, 70 TPS throughput, and complete prevention of unauthorized access attempts, outperforming centralized models. Security analysis and user surveys among repository stakeholders indicate enhanced transparency, trust, and system usability. The findings demonstrated that decentralized models significantly improve access control without compromising usability. The research contributes both theoretically and practically to secure scholarly communication in Nigeria. It aligns with evolving open access initiatives, builds local technical capacity, and proposes a replicable model for enhancing repository trustworthiness across universities in Nigeria. Future work can explore scalable, privacy-preserving extensions and AI-driven smart contract automation.