ACTION-EHR: Patient-Centric Blockchain-Based Electronic Health Record Data Management for Cancer Care

Abstract

Background With increased specialization of health care services and high levels of patient mobility, accessing health care services across multiple hospitals or clinics has become very common for diagnosis and treatment, particularly for patients with chronic diseases such as cancer. With informed knowledge of a patient’s history, physicians can make prompt clinical decisions for smarter, safer, and more efficient care. However, due to the privacy and high sensitivity of electronic health records (EHR), most EHR data sharing still happens through fax or mail due to the lack of systematic infrastructure support for secure, trustable health data sharing, which can also cause major delays in patient care. Objective Our goal was to develop a system that will facilitate secure, trustable management, sharing, and aggregation of EHR data. Our patient-centric system allows patients to manage their own health records across multiple hospitals. The system will ensure patient privacy protection and guarantee security with respect to the requirements for health care data management, including the access control policy specified by the patient. Methods We propose a permissioned blockchain-based system for EHR data sharing and integration. Each hospital will provide a blockchain node integrated with its own EHR system to form the blockchain network. A web-based interface will be used for patients and doctors to initiate EHR sharing transactions. We take a hybrid data management approach, where only management metadata will be stored on the chain. Actual EHR data, on the other hand, will be encrypted and stored off-chain in Health Insurance Portability and Accountability Act–compliant cloud-based storage. The system uses public key infrastructure–based asymmetric encryption and digital signatures to secure shared EHR data. Results In collaboration with Stony Brook University Hospital, we developed ACTION-EHR, a system for patient-centric, blockchain-based EHR data sharing and management for patient care, in particular radiation treatment for cancer. The prototype was built on Hyperledger Fabric, an open-source, permissioned blockchain framework. Data sharing transactions were implemented using chaincode and exposed as representational state transfer application programming interfaces used for the web portal for patients and users. The HL7 Fast Healthcare Interoperability Resources standard was adopted to represent shared EHR data, making it easy to interface with hospital EHR systems and integrate a patient’s EHR data. We tested the system in a distributed environment at Stony Brook University using deidentified patient data. Conclusions We studied and developed the critical technology components to enable patient-centric, blockchain-based EHR sharing to support cancer care. The prototype demonstrated the feasibility of our approach as well as some of the major challenges. The next step will be a pilot study with health care providers in both the United States and Switzerland. Our work provides an exemplar testbed to build next-generation EHR sharing infrastructures.

Application of Hyperledger in the Hospital Information Systems: A Survey

“…As shown in Figure 4(a), Alevtina Dubovitskaya [30] proposed a system for storing EHR separately. Users and nodes in the Hyperledger register and obtain identity certificates and keys through the CA.…”

An Overview of Existing Publications and Most Relevant Projects/Platforms on the Use of Blockchain in Medicine and Neurology

“…For example, there is no single national register of pharmacological therapeutic prescriptions, but a multitude of sources, often fragmented, that must be coordinated. In this scenario, it has been proposed that a secure, decentralized, and "immutable" record management system can provide faster access to the data needed at that moment (Dubovitskaya et al, 2020). Managing patients' medical data through a shared system would allow physicians to share information about patients in a secure, efficient, and fast way.…”

“…The potential of blockchain in medicine has been highlighted in some recent articles. In a systematic review by Dubovitskaya et al (2020), the importance of starting to use blockchain technology in the oncological field is emphasized, specifying how the prototypes present for general healthcare can also be applied in oncology. In case of chronic diseases such as cancer, this is particularly important, due to the multiple-medication intake, diagnosis, and treatment conducted at multiple hospitals.…”

A Risk Analysis on Blockchain Technology Usage for Electronic Health Records

“…Storing health data [39,80,82,83] With its distribution network and consensus mechanism, the Blockchain allows for a secure decentralized storing option for the massive volume of sensitive HER Sharing health data [10,15,[84][85][86][87][88][89][90][91][92] Both the health providers and especially the patients can easily access health data from any facility in a Blockchain-based system. That ensures control for the patient and fast passing-on data for optimal care Audit logging of health data [93][94][95][96][97] For audit logging, the Blockchain provides a record of all historical data of access and changes to an EHR, which can be very useful for later occurring issues with the health data content and monitor who entered a patient's EHR…”