Peng Zhang, Jules White, Douglas C. Schmidt, Gunther Lenz · 5 authors
Secure and scalable data sharing is essential for collaborative clinical decision making. Conventional clinical data efforts are often siloed, however, which creates barriers to efficient information exchange and impedes effective treatment decision made for patients. This paper provides four contributions to the study of applying blockchain technology to clinical data sharing in the context of technical requirements defined in the “Shared Nationwide Interoperability Roadmap” from the Office of the National Coordinator for Health Information Technology (ONC). First, we analyze the ONC requirements and their implications for blockchain-based systems. Second, we present FHIRChain, which is a blockchain-based architecture designed to meet ONC requirements by encapsulating the HL7 Fast Healthcare Interoperability Resources (FHIR) standard for shared clinical data. Third, we demonstrate a FHIRChain-based decentralized app using digital health identities to authenticate participants in a case study of collaborative decision making for remote cancer care. Fourth, we highlight key lessons learned from our case study.
Interoperability in healthcare has traditionally been focused around data exchange between business entities, for example, different hospital systems. However, there has been a recent push towards patient-driven interoperability, in which health data exchange is patient-mediated and patient-driven. Patient-centered interoperability, however, brings with it new challenges and requirements around security and privacy, technology, incentives, and governance that must be addressed for this type of data sharing to succeed at scale. In this paper, we look at how blockchain technology might facilitate this transition through five mechanisms: (1) digital access rules, (2) data aggregation, (3) data liquidity, (4) patient identity, and (5) data immutability. We then look at barriers to blockchain-enabled patient-driven interoperability, specifically clinical data transaction volume, privacy and security, patient engagement, and incentives. We conclude by noting that while patient-driving interoperability is an exciting trend in healthcare, given these challenges, it remains to be seen whether blockchain can facilitate the transition from institution-centric to patient-centric data sharing.
Blockchain technology is a system of creating an immutable, secure, distributed database of transactions. Blockchains were initially created to provide a distributed ledger of financial transactions that did not rely upon a central bank, credit company, or other financial institution. The technological breakthrough, however, has been extended to transactions involving legal matters, medical records, insurance billing, and smart contracts. One primary way that blockchain technology is important to healthcare professionals in that it can revolutionize medical database interoperability. This greater interoperability can help improve access to medical records, imaging archives, prescription databases. Given that a patient’s medical history is a primary cornerstone of good medicine, blockchain technology has the potential to dramatically improve medical care.
Open access
2 source records
Electronic Health Records Systems
Artificial Intelligence in Healthcare and Education
Martin Thomas Ivers, George F. Timson, Hans von Blankensee, Gary Whitfield · 6 authors
The United States Veterans Administration provides a medical care delivery system comprising more than 170 hospitals, clinics and domicilliaries. Historically, these institutions have been relatively autonomous in their day-to-day operations and consequently efforts at computerization have been difficult to adequately coordinate. A recent undertaking of the VA has been to establish decentralized coordination of planning and implementation for hospital computer systems. This presents a unique opportunity to promote standard, portable and well-designed solutions to meet the widely variable needs of a large and diverse health care delivery organization. Although computer systems for each hospital will vary with the needs of the hospital, functional program packages can be delivered and maintained in a cost-effective and manpower-efficient manner. Additionally, because all systems will be based on a common data dictionary it will be possible to gracefully expand systems as needed and to study clinical care and delivery methodologies across many institutions.
K. Kwiatkowski, Patrícia Flatley Brennan, David L. DeMets, Karen Dahlen · 5 authors
The University of Wisconsin-Madison Health Sciences Schools are currently in the planning stage of developing an Integrated Advanced Information Management System (IAIMS). The planning phase of this project attends to the unique opportunities that are found at the flagship campus of a large state university system. Statewide teaching and research initiatives and accelerated campus-level capital development challenge the planners to create an IAIMS plan that anticipates an emerging health science environment. Additionally, UW-Madison has an organizational culture with a strong tradition of faculty governance, which provides a very desirable and flexible decision-making environment for a cross-discipline collaborative information management initiative. Development of a shared IAIMS vision conflicts with a governance model that most directly supports intradepartmental decision-making. The challenge presented here for an IAIMS initiative has less to do with hard wiring a technical infrastructure and more to do with increased stakeholder cooperation in a highly decentralized organization with autonomous information systems.