Electronic Health Records are defined as developing systems that consist of a one-stop destination for a patient’s informational database and medical documentation. The data stored therein relates to medical history, test outcomes, medication, physical assessment, and treatment. EHRs are used by medical staff to give a more reliable basis for treatment, which paper records would otherwise have possibly left out (Kim & Huh, 2020). The increasing use of EHRs has seen unprecedented gains in terms of health care quality improvement and cost-cutting, hence new levels of work efficiency.
However, the new development has put medics in an awkward position owing to the legal gaps that come with it. This is because EHR systems allow for free exchange and access to patients’ medical data between staffers, without the parties necessarily seeking consent from the patient (Khezr et al., 2019). This reality can, in turn, discourage many patients from revealing their details as they are not sure how safe the information will be. The net effect of this is that it deals a blow to the perceived gains made in terms of attaining health care goals.
Studies show that tens of thousands of medical data remain at constant risk of leakage or compromise due to genuine human errors or deliberate mismanagement (Buterin, 2018). In the light of this discovery, the necessity arises to have all stakeholders converge, exchange notes, and conclusively address the legal issues surrounding EHRs.
Once the issues raised have been settled, EHR has a rich and promising potential of transforming the entire idea of health care provision. It will serve as a complete overhaul of medical services and workings, especially in modern times (Kamau et al., 2018). With the easy sharing of medical data and documents all across the field, the system dramatically moves to enhance some new echelon of a never-seen-before efficiency. This is because the digitization of patients’ health records is safely preserved, stored, and readily accessible by any other similar service provider worldwide (Jmaiel et al 2020). This level of convenience directly translates to the improvement of the quality of services offered at health facilities.
Using the paper records model, a lot of valuable information and documents are extensively reported to have gone missing either due to mishandling, natural occurrences like fire outbreaks, or misplacement (Hyperledger blockchain performance metrics, 2018). Further, the fragmented nature of storing notes and documents means that assembling them all at once proves a tall order to most parties, making it difficult, if not entirely impossible, for suitable treatment to be effected. All these, among others, are the ills and gaps that EHRs have come to cure.
Having pointed out the likely gaps that EHR systems overlooked, Blockchain then comes in handy in a concerted effort to present solutions on the table. Since Blockchain is firmly founded on the tenets of confidence and collaboration, it is a sparkle of some new light into the dark challenge of data sharing and privacy (Hyperledger Architecture, 2018). Therefore, this research paper aims to present insights on how Blockchain technology can be absorbed by and amalgamated with EHR systems to fix storage and access control issues.
Blockchain refers to a ledger protocol extended and popularized by Bitcoin (Buterin, 2018). Blockchain offers append-only, immutable, and time-stamped sequences of material and uses public-key cryptography. The original form of the Blockchain model was designed and meant for the management of financial ledgers (Hussien et al., 2019). It has, however, evolved through significant expansions to the point of accommodating automated computing instruments from all sectors, among them health care.
Usage and Benefits Of Blockchain
As discussed in the introduction, the recently unveiled health care records technology is inadequate and somewhat unreliable (Heart et al., 2017). Correcting these hitches tends to be a lengthy procedure due to the vast number of industry players involved. Since its maiden appearance years back, only light and minor changes have been effected. However, this is a drawback since technology isn’t often designed to be static (Shae, 2018). Flexibility is what keeps technological advancements trending and relevant; that is, being always open to change.
This imminent rigidity is what Blockchain comes to fix. Being a data scheme that provides security and transparency solutions, Blockchain is bound to be a game-changer in informational transactions within the medical sphere. Some of the notable areas that Blockchain seeks to address include data protection, payment complexities, technical congestion, and data usability (Hathaliya et al, 2019). This will not only hasten the medical processes but will also go a long way in effecting reduction of administrative costs as well as enhancing reliability.
While using Blockchains, the possibility of a general risk being experienced is almost non-existent (Fusco et al., 2020). Specialized care has been taken to cushion data from the dangers that bedeviled paper-stored records. Additionally, the design of this solution is such that there is room for data recovery, even in the case of natural disasters occurring. This is the extreme extent to which Blockchains have addressed safety.
The technology also speaks to the critical issue of drug traceability. This feature is to the extent that unapproved and counterfeit medicinal products are easily detected, thus keeping at bay the resultant risks of fraudulent products. Since Blockchains congregate data to a central platform, the administration is considerably eased. It means that information cannot be duplicated and manipulated without catching the attention of a second eye (Egala et al., 2021). The system’s efficiency is attained in the sense that t patients can have their information accessed at any health facility that they show up.
Following the incredible success of Bitcoin technology, Blockchain was birthed. The unveiling of this new technology form aimed to fix and stabilize users’ interactions within an unsafe system without spilling out data to third-party members (Dubovitskaya et al., 2020). There has been a continuous development of Blockchain’s building blocks since then.
Once Blockchains have been put together via a technological connection with an earlier developed block, it becomes a chain (Durneva et al., 2020). The first developed block is known as the parent block and is grouped with other blocks of genesis. This parent block carries the following pieces of information;
- Validation law is the composition of the most relevant version of chains.
- Previous block hash value: current block hash.
- Modern block generation timer.
- Merkle tree hash value showing transactions within the block.
- Target hash.
The most prominent features observable in Blockchains include digital signatures, consensus algorithms, and intelligence contracts. The digital signature is used as a mark of verification by users intending to access data from the system (Dasaklis et al., 2018). It proves the authenticity and legitimacy of a user. Every user is allocated a unique private key for access. The consensus algorithms feature works to eliminate any form of dominance by specific users. All of the data miners are fashioned to be treated equally with no regard to special rights. This enhances safety even more because it rules out any perceived conspirators (Buterin, 2018). Finally, the contract for intelligence feature automates the execution of program commands by users, thus easing human labor. Ethereum has taken its place in history as the first-ever open-source Blockchain platform to offer innovative contract languages for decentralized applications.
Data privacy issues.
Blockchain might be a promising and revolutionary technology in other fields because it helps reduce risk, stamps out fraud, and brings transparency in a scalable way for myriad uses (Manwal & Mongia, 2019). However, in the health care sector, storing patients’ data on the ledgers, which are visible to every party of the network, is a data privacy disintegration.
Transactions are unchangeable.
Data immutability is one of the significant limitations of the blockchain (Chenthara et al., 2020). Once data is created, whether mistakenly, it cannot be edited or deleted before its posted. However, this immutability cannot be achieved with an even distribution of nodes. If one participant controls 50% or more of nodes, it will retain the blockchain (Manwal et al., 2021).
Data in a blockchain can only be created but not deleted. Storing extensive medical records on the blockchain becomes inefficient and costly due to the computational and storage constraints of replicating the blockchain across every network node (Mayer et al., 2020). It is also difficult to retrieve data within a blockchain, limiting clinical, statistical, and research data use.
Blockchain Current System
Electronic health record
It has many advantages over paper records. Doctors enhance electronic health records (EHR)since it improves access to healthcare services and reduces prices. Patients’ privacy is endangered when their health information is exchanged or connected without their authorization (Minoli & Occhiogrosso, 2018). Due to a lack of trust in the system’s security, they would hide details and handle them appropriately. Patients can access new features and facilities through electronic health records whose aim is to assist inpatient treatment. The use of readable notes can help to prevent prescription, dosage, and process issues.
Harmful side effects may be reduced effectively by connecting EHRs to drug banks and clinics. This would be done by banning the prescription of drugs on which a patient previously had a harmful reaction which is often advantageous to provide direct access from anywhere at any moment. They remain in place forever and also take up less room (Nagasubramanian et al., 2020). They decrease the number of missing data points and facilitate testing efforts, including a comprehensive collection of low-cost backup data, accelerating data transfer and cost-effectiveness. EHRs have also been shown to maximize medication safety, effectiveness and reduce medical mistakes.
Blockchain Security Features
Blockchain can remain unaltered (Manwal et al., 2021). It cannot be changed, and hence the data cannot be changed with ease. Data is encrypted with a unique hash code to which the majority of the nodes must agree upon the action.
Blockchain supports peer-to-peer communication. This means that there is no central point of authority that can control it. So, a network node is considered a computer. These thousands of nodes should have a copy of the distributed ledger. This should be authenticating the transaction. If any of the nodes do not agree on a transaction, then it cannot be proceeding so it will be canceled (Manwal et al., 2021). This will protect you from a fraudulent transaction. Unlike centralized access to the central server means access to all information.
Once ledgers or data are created, they are hashed. Hashing is a method of cryptography that converts any form of data into a unique string of text. The hashed value consists of an alphanumeric string generated by each block separately (Manwal et al., 2021). This makes it very difficult to hack or change the data.
Types of Blockchain
A public blockchain is likely to be seen as an unapproved record if anyone can access the organization’s hubs over the Internet (for example, Bitcoin or Ethereum). They are permissionless and allow anyone to join.
Permissioned Blockchain (Private)
The return of the average entity is allowed by this kind of restricted Blockchain. Strictly regulate data connectivity on private blockchain networks. There are few nodes in the Blockchain resulting in less processing time per transaction.
It is a combination of public-private blockchain unions, which is seen as half-decentralized (Prokofieva & Miah, 2019). Each information exchange can be public or private in the blockchain business, and hubs reserve the choice to choose.
Questions About Blockchain Overcoming Security Issues in Healthcare EHR
What are some of the hindrances and arising questions revolving EHRs in the blockchain technology age?
This aimed to answer queries regarding obstacles, facets, problems, common issues, and unanswered questions in blockchain technology and HER (Sample Medical Record, 2019). Some primary concerns and problems in EHR blockchain literature comprise authorization, interoperability, and confidentiality. Additional challenges arise due to interoperability issues between healthcare insurers and networks. Also, patient files holding essential data become uncoordinated and disjointed due to a lack of structured data distribution and collection (Shae & Tsai, 2019). Various studies illustrate their doubts concerning data interoperability and fragmentation. Therefore, studies suggest that legislative compliance and open standards may be applied to handle such concerns. Architecture may outperform conventional networks given the distribution of health-related data, which is the blockchain dispersed record technology (Buterin, 2015).
What is the meaning of EHR taxonomy in blockchain technology?
The taxonomy helps to comprehend and define blockchain EHR better (Beinke e al., 2019). The primary aim of taxonomy is to include a framework for classifying and succinct corpus thoughts by explaining relationships and interpretations. The literature review explored several research articles and publications in EHR and blockchain technology. The taxonomy aims to respond to the general question, collecting and organizing various options relevant to the analysis (Shen et al., 2019). Also, taxonomy helps in the clarification of the illustration of core EHR elements and blockchain technology.
What healthcare guidelines and principles can we implement in the blockchain network?
Healthcare providers should arrange their health data using proprietary and open models. These models are usually used for internal uses and may be in various formats. EHRs are not meant to deal with multiple patient institutions and long-life care (Shi et al., 2020). Patients distribute records around organizations, and activities transfer within suppliers.
What are the primary opinions relating to the application of blockchain in healthcare?
The study’s literature review focused on the primary principles relating to blockchain technology. Blockchain’s register contains crucial info such as users, period, transaction amount, and year. All nodes in the system consist of an entire blockchain duplicate and bitcoin miners, which uses cryptographic ideas for monitoring transactions. The nodes guarantee immediate and consistent agreement with the ledger’s current operations and conditions (Sookhak et al., 2020). When a contract is tampered with, nodes have no arrangements; thus, the transactions are not binding to blockchain technology. In confidentiality, the primary principle is to protect patients’ info in the system, which has been the inaccessibility of data apart from those with medical care interests.
In what ways can blockchain hold ever-growing patient medical records and data in the future?
Blockchain technology facilitates the potential of transition and evolution in its lifetime (Ali, 2017). The technology is essential in tracking consistent transactions shifts. EHR records are more extensive, similar to those individuals they serve. Regarding the flow of money, the population is growing slower than inflation which can be illustrated in the bitcoin blockchain (Tariq et al, 2020). Blockchain mechanism helps to preserve greater medical records and maintain a growing connected medical documents database.