Not all Blockchains are created equal. Not all EHR solutions are either…
Satoshi released the white paper on Bitcoin in 2008 and since that moment the world has been spinning into a crypto-frenzy. There is no doubt that blockchain technology promises to change the way we interact and trust each other in the digital realm. Don and Alex Tapscott’s book ‘Blockchain Revolution’ covers the broad scope of the potential innovations very eloquently. I have full confidence that the “internet of value” will be underpinned by some form of blockchain implementation.
Purists of the original ideology have quite fixed ideas about what a blockchain should look like. It feels almost like early biblical times when different factions were fighting for dominance — such is the impact of this technological promise. A new doctrine, a new way — in code we trust.
I am a little more sanguine about things. Like evolutionary theorists, I see progress and innovation more as an emerging phenomenon with some radical disruptions along the way — part design, part accident and the occasional meteor strike that changes the status quo in an instant. Bitcoin was the radical disruption because it introduced a solution to the Byzantine General’s Problem and provided a mechanism to achieve distributed consensus. But it is not perfect. It is energy intensive, lacks privacy and is difficult to scale. That said, its open, decentralised, censorship resistant and borderless properties have enormous value and appeal.
Proof of Work has its place, but as we move forward we need to consider the possibilities that there are better alternatives (at least in certain contexts).
Bitcoin Maximalists will argue that all future functionality must be built upon the original script. Not all agree.
There is bound to be much debate and perhaps crypto-unrest as the different factions fork and fight to lead us out of the darkness into the light. Money (where blockchain had its beginnings) is as divisive as religious dogma. It is not always easy to tease out the motivations behind forks and the swings in the price of each new currency. But perhaps we can take the positive messages and the commonality from each philosophical platform and build something that has utility for all. Data is the new asset and transferring this valuable resource about requires trust.
My article last week examined the stakeholder values to be derived in the design of Electronic Healthcare Records (EHR). Using these requirements aids our choice of blockchain and ensures we build a solution that serves patients and professionals.
This week I would like to explore the choices we at Medicalchain have made for our blockchains and how we feel we are providing the best options currently available.
Of primary concern to us is patient privacy and data security. Whilst some of our EHR competitors have elected to build primarily with Ethereum, we have taken the view that Hyperledger Fabric works best for this function. We believe that access control to health records should remain with patients.
Equally important is the ability to selectively share data from those records. Current (non-blockchain) EHR offerings are very much an all or nothing affair. Once logged in, the entire record is visible. With Hyperledger, patients are able to decide what level of data others can see — time and content limited access.
Universal access is another important role demanded of EHR users. But while this is essential, it is also true that the data needs to be securely protected. For this reason, we have elected to keep records separate and encrypted.
The Medicalchain system uses a double encryption mechanism on a closed, permissioned based blockchain. Patient data is not accessible directly on the blockchain (which rather acts as a pointer to where encrypted patient data is held). Permissioned systems restrict participants in the network to those that have been vetted. Decentralised maintenance of the blockchain can then occur through trusted entities. Hyperledger Fabric is supported by the Linux Foundation and as such has much credibility. Their open standard is important for the security and future development of blockchains as they evolve and mature.
Another major benefit of using this system is its scalability and transaction throughput capabilities. Hyperledger is designed for enterprise use and its modular architecture allows for implementations across a range of industries. Because Medicalchain is a global endeavour, being able to accommodate high volumes of instant access transactions is crucial. Hyperledger offers to meet these demands more than Ethereum at present. The consensus mechanism employed is less restrictive and arduous — principally because not all participants in the network need to agree on all transactions.
As the number of point of care devices increases, so too will the amount of patient generated data being streamed to health records. This needs consideration as the number of users and data traffic grows. We have therefore chosen a solution that accommodates these requirements.
The astute amongst you may have read our whitepaper and noticed that we are using a dual blockchain solution. Whilst the first blockchain controls access to health records and is built using Hyperledger Fabric, the second blockchain is powered by an ERC20 token on Ethereum. Hyperledger is able to deal with smart contracts via chaincode while Ethereum will function as the payment vehicle and token host.
Deciding on blockchains is only part of the way Medicalchain differentiates from the alternatives.
Of major importance is the fact that we have already produced a product that is currently in use. Discharge Summary, version one and the precursor to Medicalchain has been used in several hospitals for some time now. The intangible value of knowledge gained by being in the market for several years is not to be ignored.
Several telemedicine platforms are already available for use. However, none of them provide access to EHR data. The implications of this are far-reaching. Patients and doctors can both be confident that health decisions are being taken with the most comprehensive and up to date patient information available. We believe this adds not only convenience and cost benefits but also a much safer standard of clinical care.
Medicalchain is providing emergency bracelets to enable access in emergency settings. This critical feature adds a further level of safety and confidence to patients.
One final but enormously compelling argument to choose this company over the others is the quality of the team. With several highly qualified doctors and allied clinical professionals on board (all of whom are very familiar and passionate about blockchain technology), Medicalchain has access to relevant on-the-ground experience. The development team has extensive blockchain and IT security credibility and the legal and economic advisors are second to none.
You may say that I am biased because I am involved with the company. I agree, I am. But considering the reasons above, I think it is clear why I choose to be a part of it. Medicalchain is without doubt the best option available. And I am proud to be a part of helping them bring healthcare into the future.
As always, please get in touch with comments or questions by email: stewart@medicalchain.com
See you next week!
