A robust sharing and interoperability infrastructure, flexible enough to permit instant access to EHRs on a need-to-know basis, yet offering watertight security against unauthorized or malicious access, is an important need that can be addressed with blockchain technology.
“The potential [of blockchain technology] within healthcare is becoming clear, perhaps most importantly as a way to facilitate electronic health record (EHR) operability,” argue the authors of the white paper:
“We believe that by using blockchain technology, the following three major features of EHR systems can be enhanced: immutability via file integrity; cybersecurity via data access management; and interoperability via collaborative version control.
“In a time of increased electronic data, blockchain technology can organize access to that data in such a way that it can be recorded and verified only through consensus of all parties involved. For clinicians, blockchains can support universal identifiers for any data entered into an EHR, which is then available to other authorized providers and care team members.
“Patients can monitor their own health information, approving, denying or sharing changes to their data, ensuring a higher level of privacy and engagement. Researchers will benefit from better data integrity and reliability, creating a ‘platform of trust’ for data sharing. Payers will have better data reconciliation, fewer errors and frauds, reduced administrative and claim processing costs, and the potential to reach underserved markets.“
The white paper outlines the building blocks of a proof-of-concept blockchain technology application able to provide EHR systems with better integrity, cybersecurity and interoperability characteristics. The proof-of-concept application is built on top of GemOS, a blockchain “operating system” developed by Gem, which provides the basic infrastructure needed to access, query, program, record and authenticate information on a blockchain. GemOS is part of Gem Health, a recently launched network for developing applications and shared infrastructure for healthcare powered by blockchain technology. The launch of Gem Health and the fast-growing impact of distributed ledgers in the healthcare sector were covered in a previous issue of Distributed.
In the proof-of-concept EHR example, the blockchain’s ledger is a shared registry of events and messages. Blockchain applications communicate with GemOS, which connects to the underlying ledger to facilitate regulated information exchange in a network that connects patients, payers and healthcare providers.
GemOS has four components, explains the white paper: Logic, Data, Identity and Network:
“Network interacts directly with the blockchain, while Logic is abstracted from the blockchain and interacts with applications. Just as the internet has basic protocols that transmit bits, and then a stack of software to make those bits accessible to common applications, GemOS provides a stack of software that takes the information in blockchains and makes it accessible to healthcare applications that patients, providers and payers utilize.”
The Ark Invest and Gem white paper emphasizes that the actual data is not stored in the blockchain. The blockchain simply records minimal information that validates content and points to where the rest of the record can be found.
“Blockchain technology provides hope that [an interoperable architecture of trust] is possible,” concludes the white paper. “It differentiates from past solutions in its ability to facilitate health information exchange through a decentralized architecture. This decentralized architecture is tamper-proof and resilient when compared to centralized solutions, allowing for an immutable, secure and shared library of health data.”