A Patient-Centric Health Information Exchange Framework Using Blockchain Technology

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.

[1]  D. Blumenthal Stimulating the adoption of health information technology. , 2009, The West Virginia medical journal.

[2]  Chi-Ren Shyu,et al.  Applying Blockchain Technology to Enhance Clinical Trial Recruitment , 2020, AMIA.

[3]  James J. Cimino,et al.  Consumer-mediated health information exchanges: The 2012 ACMI debate , 2014, J. Biomed. Informatics.

[4]  Madison N. Ngafeeson Healthcare Information Systems: Opportunities and Challenges , 2015 .

[5]  Douglas B. McCarthy,et al.  Learning from Health Information Exchange Technical Architecture and Implementation in Seven Beacon Communities , 2014, EGEMS.

[6]  Reuben Grinberg Bitcoin: An Innovative Alternative Digital Currency , 2011 .

[7]  Melissa M. Goldstein,et al.  Data Segmentation in Electronic Health Information Exchange: Policy Considerations and Analysis , 2010 .

[8]  L. Schilling,et al.  Systematic Review of Health Information Exchange in Primary Care Practices , 2010, The Journal of the American Board of Family Medicine.

[9]  Joshua R. Vest,et al.  Health information exchange: persistent challenges and new strategies , 2010, J. Am. Medical Informatics Assoc..

[10]  Fang Liu,et al.  Blockchain Technology for Detecting Falsified and Substandard Drugs in Distribution: Pharmaceutical Supply Chain Intervention , 2018, JMIR research protocols.

[11]  Gary L. Kreps,et al.  Consumers’ Perceptions About and Use of the Internet for Personal Health Records and Health Information Exchange: Analysis of the 2007 Health Information National Trends Survey , 2010, Journal of medical Internet research.

[12]  Paul G Shekelle,et al.  Usage and Effect of Health Information Exchange , 2014, Annals of Internal Medicine.

[13]  Sachin Shetty,et al.  ProvChain: A Blockchain-Based Data Provenance Architecture in Cloud Environment with Enhanced Privacy and Availability , 2017, 2017 17th IEEE/ACM International Symposium on Cluster, Cloud and Grid Computing (CCGRID).

[14]  Douglas C. Schmidt,et al.  FHIRChain: Applying Blockchain to Securely and Scalably Share Clinical Data , 2018, Computational and structural biotechnology journal.

[15]  Chi-Ren Shyu,et al.  Applying Blockchain Technology for Health Information Exchange and Persistent Monitoring for Clinical Trials , 2018, AMIA.

[16]  Tsung-Ting Kuo,et al.  Comparison of blockchain platforms: a systematic review and healthcare examples , 2019, J. Am. Medical Informatics Assoc..

[17]  Claudia H. Williams,et al.  From the Office of the National Coordinator: the strategy for advancing the exchange of health information. , 2012, Health affairs.

[18]  Kim-Kwang Raymond Choo,et al.  Blockchain: A Panacea for Healthcare Cloud-Based Data Security and Privacy? , 2018, IEEE Cloud Computing.

[19]  Nate C. Apathy,et al.  Hospital adoption of API-enabled patient data access. , 2019, Healthcare.

[20]  David T. Marc,et al.  Why Patient Matching Is a Challenge: Research on Master Patient Index (MPI) Data Discrepancies in Key Identifying Fields. , 2016, Perspectives in health information management.

[21]  Pallavi Ranade-Kharkar,et al.  Improving Clinical Data Integrity by using Data Adjudication Techniques for Data Received through a Health Information Exchange (HIE) , 2014, AMIA.

[22]  Saurabh Rahurkar,et al.  Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. , 2015, Health affairs.

[23]  Richard C. Holt,et al.  The Turing programming language , 1988, CACM.

[24]  Kamran Sartipi,et al.  HL7 FHIR: An Agile and RESTful approach to healthcare information exchange , 2013, Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems.

[25]  Christopher A. Harle,et al.  The benefits of health information exchange: an updated systematic review , 2018, J. Am. Medical Informatics Assoc..

[26]  Jessica S. Ancker,et al.  Consumer experience with and attitudes toward health information technology: a nationwide survey , 2013, J. Am. Medical Informatics Assoc..

[27]  Alex Pentland,et al.  Decentralizing Privacy: Using Blockchain to Protect Personal Data , 2015, 2015 IEEE Security and Privacy Workshops.

[28]  M Terry,et al.  Medical identity theft and telemedicine security. , 2009, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[29]  Shaun J. Grannis,et al.  Examining the Heartland Region Pilot: First Look at the Patient-Centered Data HomeTM Framework , 2018, AMIA.

[30]  Vishal Patel,et al.  A framework for secure and decentralized sharing of medical imaging data via blockchain consensus , 2019, Health Informatics J..

[31]  D. Bates,et al.  Patients’ Attitudes Toward Electronic Health Information Exchange: Qualitative Study , 2009, Journal of medical Internet research.

[32]  Hyeon-Eui Kim,et al.  Blockchain distributed ledger technologies for biomedical and health care applications , 2017, J. Am. Medical Informatics Assoc..

[33]  Alessandro Acquisti,et al.  Do Data Breaches Disclosure Laws Reduce Identity Theft? , 2010, WEIS.

[34]  S. Weingarten,et al.  Choosing Wisely clinical decision support adherence and associated inpatient outcomes. , 2018, The American journal of managed care.

[35]  Joseph Price Reducing the Risk of a Data Breach Using Effective Compliance Programs , 2014 .

[36]  Jules White,et al.  Chapter One - Blockchain Technology Use Cases in Healthcare , 2018, Adv. Comput..

[37]  P J Schneider,et al.  ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing--2001. , 2001, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.