How IBM blockchain can solve the problem of continuity of care -an effort from LMS India:

Electronic medical records (EMRs) are critical, highly sensitive private information in healthcare, and need to be frequently shared among peers such as healthcare providers, insurance companies, pharmacies, researchers, patients families and among others. Blockchain provides a shared, immutable and transparent history of all the transactions to build applications with trust, accountability, and transparency. This provides a unique opportunity to develop a secure and trustable EMR data management and sharing system using blockchain.

Using blockchain technology for primary patient care can help to address the following problems of the current healthcare systems.

A patient often visits multiple disconnected Healthcare Providers. He has to keep the history of all his data and maintain the updates. This leads to the situation when the required information may not be available.
Due to the unavailability of the data, the patient may have to repeat some tests for laboratory results. This is common when the results are stored in another hospital and cannot be immediately accessed.
The healthcare data are sensitive and their management is cumbersome. Yet, there is no privacy-preserving system in clinical practice that allows patients to maintain access control policy in an efficient manner.
Sharing data between different healthcare providers may require major effort and could be time-consuming.
Patient access to their own health information. Authorize Healthcare Providers to access their records.
Relying on the centralized entity that would store and manage the patients’ data and access control policies mean having a single point of failure and a bottleneck of the whole framework.

The possibility of using blockchain for healthcare data management has recently raised a lot of attention. In our work, we focus on the practical implementation of a system that uses blockchain technology and can be integrated into clinical practice. We employ permission blockchain technology to maintain metadata and access control policy. Combining these technologies allows us to guarantee data security and privacy as well as availability with respect to the access control policy defined by the patient.

1. Near real-time secure and authorization based seamless transmission of electronic medical records. 
2. through the use of blockchain only a health record ledger is created. Which means it cannot be altered without patients permission. 
3. Integration with proprietary EMR System with blockchain network. From within this system, we will load patient records and have it communicate with the blockchain through the patient’s approval. data will be transferred from a proprietary EMR system to the blockchain.

Blockchain provides a unique opportunity to support healthcare. Our EHR Solution enables the user to give healthcare professionals access to their personal health data. EHR Solution then records interactions with this data in an auditable, transparent and secure way on systems distributed ledger.

Lastly, Our EHR Solution is a platform for others to use that complement and improve the user experience. Users will be able to leverage their medical data to power a plethora of applications and services. Our Solution improves care for people by placing the patient at the center of the digital transformation of healthcare. In order to be provided with the best care patients not only can but must have control over their own data.

The blockchain is a peer-to-peer distributed ledger technology that was initially used in the financial industry. Based on how the identity of a user is defined within a network, one could distinguish between permission and permissionless blockchain systems. A permissionless system is one in which the identities of participants are either pseudonymous or even anonymous and every user may append a new block to the ledger. In contrast, in the case of a permission blockchain, the identity of a user is controlled by an identity provider. The identity provider is trusted to maintain access control within the network and the user’s rights to participate in the consensus or validate a new block. Next, we introduce two most well-known implementations of the blockchain technology: Ethereum and Hyperledger.

The Hyperledger blockchain network is permission-based and requires users to sign up to use it. Permissioning on the network is controlled using Hyperledger modeling and access control languages. Hyperledger Fabric is a platform for distributed ledger solutions underpinned by a modular architecture delivering high degrees of confidentiality, resilience, flexibility, and scalability. Medical information is often highly sensitive, in both a social and legal sense, so a closed blockchain such as Hyperledger Fabric helps to retain the necessary privacy required for such an application. Hyperledger Fabric is a better solution for managing access to health records, as it accommodates for multiple layers of permission, meaning the owner of a set of data can control which parts of their data is accessed.

Participants Definitions and Permissions With a plethora of different actors, identity management and access to data is key to our EHR solution. A dynamic system has been developed that identifies actors and gives them the appropriate scope over a health record, contingent on the patient’s permission.

Below are some examples of read/write permission:

ParticipantPermissionsPatient@ Create/READ/Update Own record 
@ Revoke permission from Practitioners/Institutions. 
@ Permission a Practitioner/Institution to Read/Write EHR or a portion of their EHR 
@ Write certain attributes to EHR : 
- Amount of tobacco consumed daily 
- Alcohol consumed weekly 
- Weekly exercise 
@ Able to search available Clinicians/Labs in the network.Clinician / Labs@ Read/Write on permission EHRs 
@ Able to search avaialble Clinicians/Labs in network.

Patient Granting Access

• Patient A grants access to EHR to Practitioner A

• Practitioner A’s ID is added to Patient A’s authorized asset on the ledger

• Patient A’s ID is added to Practitioner A’s authorised asset on the ledger

• The Symmetric key for the EHR is decrypted with Patient A’s private key

• The symmetric key is then encrypted with Practitioner A’s public key

Patient Revoking Access

• Patient A revokes access from Practitioner A

• Practitioner A’s ID is removed from Patient A’s authorized asset

• Patient A’s ID is removed from Practitioner A’s authorized asset

• Patient A’s private key is used to decrypt Symmetric key for EHR which is used to decrypt the EHR

• The EHR is encrypted with a new Symmetric key

  • The new Symmetric key is encrypted with Patient A’s public key and the public keys of all the remaining IDs that have permission

In the current health care system, patients have their health information spread over multiple systems, hospitals, networks, and potentially countries. There are multiple fragmented records of the same patient, held at different institutions with their own snapshot of the patient’s health during their interaction with them such as blood tests, imaging, and clinic letters. EHR Solution will order and filter all of these records into a chronological order and the specific categories above to aid data handling. Such categorization would make the records more accessible and understandable for patients, and also facilitate researchers in seeking out the information important to them.

A patient can generally grant or decline health care professionals access to their records. However, in the event of an emergency and with the patient incapacitated, there must be an ability to view certain information in order to provide the best possible care. The most vital information needed in an emergency would be the patient’s name, their next of kin, medications, allergies and any advanced decisions they may have made. Patients using the platform will have the ability to select in advance which areas of their records can be viewed in an emergency situation.

Youtube link of the Demo:

https://youtu.be/JbOSQINvCT0


Originally published at medium.com on November 29, 2018.