Blockchain vehicles for efficient Medical Record management

Abstract

The lack of interoperability in Britain's medical records systems precludes the realisation of benefits generated by increased spending elsewhere in healthcare. Growing concerns regarding the security of online medical data following breaches, and regarding regulations governing data ownership, mandate strict parameters in the development of efficient methods to administrate medical records. Furthermore, consideration must be placed on the rise of connected devices, which vastly increase the amount of data that can be collected in order to improve a patient's long-term health outcomes. Increasing numbers of healthcare systems are developing Blockchain-based systems to manage medical data. A Blockchain is a decentralised, continuously growing online ledger of records, validated by members of the network. Traditionally used to manage cryptocurrency records, distributed ledger technology can be applied to various aspects of healthcare. In this manuscript, we focus on how Electronic Medical Records in particular can be managed by Blockchain, and how the introduction of this novel technology can create a more efficient and interoperable infrastructure to manage records that leads to improved healthcare outcomes, while maintaining patient data ownership and without compromising privacy or security of sensitive data.

Keywords: Health care; Information technology.

Fig. 1. Progress of a Blockchain transaction.

Public-key cryptography creates a public and a private key for each user, using a one-way hash function to create the public from the private key. The public keys are used by the sender and receiver of a transaction to identify each other. Private keys remain undisclosed, and are used by the sender and receiver to sign and verify transactions, respectively. Here, User 1 sends a transaction to User 2, using User 2’s Public key. User 2 receives the transaction, identified as having been sent by User 1’s public key.

Fig. 2. Interactions in the Blockchain-based healthcare system.

Patients have full access to the data via the EMR Client. Data may be added or viewed by doctors and other providers, who require permissions to do so, and added by devices including wearables, which form a part of the Internet of Things (IoT). All interactions are stored on the Blockchain.

Fig. 3. Connecting independent healthcare providers.

Each box represents a Blockchain ledger. The Patient Directory lists all pseudonymised patients about whom data is stored across all providers’ Blockchain ledgers. Associated with each patient is a pointer to all centres (represented by number) where that individual has had a medical interaction. Individual Centres store their own ledgers, containing more detailed metadata (represented by code, e.g. Data A1, which does not imply storage of sensitive medical information) about interactions with patients, including associated cloud-based data storage locations and access permission information. When a Centre joins the system (e.g. Centre 3), basic pseudonymised information about its patients is relayed to the Patient Directory, allowing other Centres to access that information, subject to any associated smart contract-based permissions.