A Distributed Ledger Architecture for Cross-Jurisdictional Healthcare Professional Authentication and Tracking in Universal EHR Systems

Abstract

While there are mechanisms for identifying patients and professionals in most jurisdictions, cross-jurisdictional identification of who accessed health information remains a significant challenge. Initiatives like EHDS, TEHDAS, XpanDH and the European Electronic Health Record Exchange Format (EEHRxF), and xShare have been working to enable cross-border health data usage for healthcare, research, and policy purposes, by proposing and establishing legal, operational and technical foundations. However, the absence of global healthcare professional databases and federated identification and authentication mechanisms perpetuates some challenges for cross-border usage at scale. Based on the work of the EU-funded Blockchain.PT R&D initiative, we propose a distributed ledger technology (DLT)-based architecture and protocol to support a universal EHR system, which combines standardized off-chain storage of sensitive health data with an on-chain layer utilising smart contracts for data certification, access management, and logging of consent and data sharing, processing and transfer agreements. The architecture addresses key requirements of the EHR lifecycle and incorporates emerging decentralised digital identity, authentication and verification protocols to establish the trust layer between the several participants of the healthcare value chain, put citizens in control of their data and partially disintermediate health data exchange and verification. Leveraging the emerging DLT infrastructures such as EBSI/Europeum, and on established digital identity regulations and frameworks such as eIDAS and EUDI, we propose to develop on this EHR-focused architecture and protocol and integrate cross-jurisdictional healthcare professional identification and authentication capabilities. The combination of a universal EHR system with a trusted healthcare professional identity and access management layer could work as a cornerstone for realising the EHDS vision.