Abstract
Interoperability in Electronic Health Records (EHR) is significant for the seamless sharing of information amongst different healthcare stakeholders. Interoperability in EHR aims to devise agreements in its interpretation, access, and storage with security, privacy, and trust. A study and survey of state-of-the-art literature, prototypes, and projects in standardization of the EHR structure, privacy-preservation, and EHR sharing are very essential. The presented work conducts a systematic literature review to address four research questions. 1) What are the different standards for common interpretation, representation, and modeling of EHR to achieve semantic interoperability? 2) What are the different privacy-preservation techniques and security standards for EHR data storage? 3) How mature is blockchain technology for building interoperable, privacy-preserving solutions for EHR storage and sharing? 4) What is the state-of-the-art for cross-chain interoperability for EHR sharing? An exhaustive study of these questions establishes the potential of a blockchain-based EHR management framework in privacy preservation, access control and efficient storage. The study also unveils challenges in the adoption of blockchain in EHR management with the state-of-the-art maturity of cross-chain interoperable solutions for sharing EHR amongst stakeholders on different blockchain platforms. The research gaps culminate in proposing a blockchain-based EHR framework with privacy preservation and access control design. The proposed framework employs partitioning of EHR to on-chain and off-chain storages for performance guarantees with the retrieval of valid off-chain data. The framework is deployed on the Ethereum test network with Solidity smart contracts. It is observed that different test cases on the partitioning of the EHR data, yielded better read-write throughput and effective gas price than fully on-chain storage.
Highlights
Interoperability in the healthcare sector is the ability of the healthcare systems to share, interpret and use Electronic Health Record (EHR) coherently [1]
1) What are the different standards for common interpretation, representation, and modeling of Electronic Health Records (EHR) to achieve semantic interoperability? 2) What are the different privacy-preservation techniques and security standards for EHR data storage? 3) How mature is blockchain technology for building interoperable, privacy-preserving solutions for EHR storage and sharing? 4) What is the state-of-the-art for cross-chain interoperability for EHR sharing? An exhaustive study of these questions establishes the potential of a blockchain-based EHR management framework in privacy preservation, access control and efficient storage
Semantic interoperability [26]: This study focuses on standards in EHR structure [9] [27,28,29,30,31], representation [9] [32,33,34,35,36,37,38,39], and data modeling techniques [12] [40,41,42,43,44,45,46,47] that can be suitable for EHR. b
Summary
Interoperability in the healthcare sector is the ability of the healthcare systems to share, interpret and use Electronic Health Record (EHR) coherently [1]. Interoperable solutions to EHR management are critical for seamless transfers of patient data and treatment details for improving the effectiveness of healthcare services with reduced cost and time. EHR refers to patient data that is recorded, processed, and analyzed at various healthcare organizations [2]. As this data originates from different organizations, it follows local standards and healthcare terminologies. The EHR standards of different healthcare organizations are not uniform, causing a low level of interoperability in healthcare information systems among the organizations [3] [4]. EHR sharing and interoperability amongst the different healthcare organizations is a critical area of research [5]
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