Designing and testing a blockchain application for patient identity management in healthcare

Abstract

Objective Healthcare systems suffer from a lack of interoperability that creates “data silos,” causing patient linkage and data sharing problems. Blockchain technology’s unique architecture provides individuals greater control over their information and may help address some of the problems related to health data. A multidisciplinary team designed and tested a blockchain application, MediLinker, as a patient-centric identity management system. Methods The study used simulated data of “avatars” representing different types of patients. Thirty study participants were enrolled to visit simulated clinics, and perform various activities using MediLinker. Evaluation was based on Bouras’ criteria for patient-centric identity management and on the number of errors in entry and sharing of data by participants. Results Twenty-nine of the 30 participants completed all study activities. MediLinker fulfilled all of Bouras’ criteria except for one which was not testable. A majority of data errors were due to user error, such as wrong formatting and misspellings. Generally, the number of errors decreased with time. Due to COVID-19, sprint 2 was completed using “virtual” clinic visits. The number of user errors were less in virtual visits than in personal visits. Discussion The evaluation of MediLinker provides some evidence of the potential of a patient-centric identity management system using blockchain technology. The results showed a working system where patients have greater control over their information and can also easily provide consent for use of their data. Conclusion Blockchain applications for identity management hold great promise for use in healthcare but further research is needed before real-world adoption.

Improving Transitions of Care: Designing a Blockchain Application for Patient Identity Management

“…MediLinker is a blockchain-based decentralized identity management solution, 14 which provides patients autonomy in managing their self-sovereign identity and medical information. It is designed by keeping seven scenarios in mind.…”

“…This study expanded upon previous work with Me-diLinker 14 to better simulate healthcare delivery using 20 unique use case avatars that represented a wide range of patient demographics. We expanded our testing with patient avatars focusing on guardianship and the unique challenges faced by a COVID-19 diagnosis.…”

“…Although we did not get 100% accuracy for any credential, these results are much better than that in phase 1 of the simulation study. 14 All errors occurred during data entry and verification, which were categorized as workflow vulnerability rather than an error with MediLinker. Table 2 presents details of all data-entry errors made by patients.…”

“…In our prior work, we created 15 use case scenarios and applied the theoretical framework developed by Bouras et al to test the effectiveness of MediLinker in fulfilling the criteria of identity management. 14,15 We were able to demonstrate proof of identity and consent for sharing of personal health data during testing, although we did not evaluate user perceptions at that time. In this article, we describe the testing of the second iteration of MediLinker, 16 which was redeveloped as a robust custom-built iOS application to further expand on use case testing of interoperability, patient guardianship, as well as further development of patient data consenting, sharing, and revocation.…”

Empowering Patients in the U.S. Health System by Using Blockchain Technology

“…In our pilot, conducted on the campus of the University of Texas at Austin with 30 participants using synthetic personal data, the MediLinker system was able to allow all the tasks to be performed adequately. The results of this pilot have been published elsewhere [24].…”