How are the plans about blockchain for OpenEhr? Is there any plan to incorporate it in the standard, or is it regarded as a technical implementers business?
Bert
what would it do?
Grahame
Hi Bert,
Where do you want to apply it?
Hi Bert,
I think this highly depends on the color of the blockchain.
Best,
Birger
For example to guarantee a position of a composition in a chain of events, or use it in audits for the same purpose.
There is a lot of noise about blockchain in health-ict. So, I wonder if there are plans to incorporate it in the standard. But maybe it is regarded as something technical OpenEhr does not want to get involved with.
Bert
Hi Bert,
I think this highly depends on the color of the blockchain.
Perhaps an optional Blockchain capability could be added in the service model, at points where an
"internal" system had to interface with one or more "external" systems.
For example, you could provide access to a specific dataset and blockchain calls that
modify its state.
This would then also require the extension of the service model for verifying certain actions
against the blockchain.
Within the RM, there is the Feeder System Audit (http://www.openehr.org/releases/RM/latest/docs/common/common.html#_feeder_system_audit)
It's a new concept, still needs use cases about it I think.
All the best
Athanasios Anastasiou
Sorry, I could not resist
What problem is BlockChain solving, that deployed technologies can not solve?
Gerard Freriks
+31 620347088
gfrer@luna.nl
better an old joke then everybody sad
Not very far from now (looking into the future, Scotty and Captain Kirk), health information will be a worldwide web.
Mayor players are diving into this trillion dollar business.
Health information will need to be accessible, and blockchain can be used to guard all interaction between systems.
You can find dozens of documents which handle about this.
In the Netherlands Nictiz is busy with it.
For example read this (sorry, only Dutch)
https://www.nictiz.nl/SiteCollectionDocuments/Whitepapers/Blockchain_in_de_zorg.pdf
Summarizing:
- Blockchain is needed when interacting parties do not trust or know each other
- A trusted third party cannot be found or is not desirable
- Validity en transparency of transactions is important
- Stored or interchanged data are very important
I think the first point is key:
I don’t really see an scenario where your health data would be sent to an untrusted source. But maybe in a future where we can envision an “ebay-like” service of distributed medical services or something like that
I agree, I was referring to more use cases with the outlook of incorporating blockchain into the existing
openEHR model. Not blockchain itself.
(The bit about interacting parties is the "maybe add it in the service model" (?))
What problem is BlockChain solving, that deployed technologies can not solve?
Read the document I linked to in my previous message, you can read dutch.
Maybe, I am not the specialist. I was wondering if or why it is (not) discussed in the OpenEhr circles (as far as I can see them)
Best regards
Bert
I am sceptical of most use cases of block chain outside payments witnessing in some limited trading schemes. There are 2 inter-related problems.
-
block chain is a very inefficient solution to a problem that largely does not exist in healthcare: untamperable evidence that something happened, in the context of not having any trustable governor. In almost all cases, we actually want to be able to tamper with the record - except the audit trail. And/or suppress data from being visible except to a few authorised parties. For the audit trail, the average institution generates more data per day than block chain presently holds - we are talking vast amounts of data
-
the inefficiency is considerable - full block chain requires some benefit to the miners - and in any volume of data, the price is considerable (e.g. blockchain consumes more power than nigeria, I read this week); that is not evident in any scheme I’ve seen, but schemes that have restricted mining loads require restricted attack surfaces, and I don’t believe that there’s a sweet spot there in healthcare
There are some interesting use cases around selective sharing data for research using active blockchains (e.g. ethereum) but by and large these seem outside the scope of records and EHRs to me
Grahame
Depends on how you define trusted. First of course there are the rights from the other to send/receive information, second is the transparency, a patient must be able to know who has received his data and which data. Blockchain can help in legal proceedings afterwards to proof why and when and how someone or some instance received information. I think this will be very important in the near future when there will be more and more data-exchange. Not all countries have their healthcare governed in a single organization, but have many healthcare organizations, which can work together on curing a single patient. Someone I know has now a medical problem with one of her legs. She is receiving healthcare from five parties, just to work on that problem: a specialist, the GP, a physiotherapist, a special shoemaker and the employer which needs to arrange special working place. That is the reality today, this will become more and more soon. Bert
I heard too about the enormous energy used by miners, and I heard also some solutions for health-ICT.
Because the miners in Health-ICT are nor working as fast as they can with dollar-signs in their eyes to create money, but they only create keys to facilitate the needed processes. So, maybe the idle running servers an create blocks, and they can use alternative methods which have other quality-features then the bitcoin, because they have another purpose. I don't know if it is feasible, but there are many publications about this subject.
About the data-state. In OpenEhr there is a state-machine, which has, at this moment no defined secure mechanism to ensure that the states truly reflect reality.
Maybe OpenEhr is not the place to define that, that is my original question.
But if OpenEhr wants to secure the states of the statemachine, blockchain can help.
For example, there is the often used medication-delivery-example. It has been subscribed, delivered, and the patient has taken it or stopped it, etc.
A chain of these connected events can be ensured truly happened if they are connected with blockchain. Their place in the chain of events is secured, and not changeable.
Bert
see below.
Gerard Freriks
+31 620347088
gfrer@luna.nl
Not very far from now (looking into the future, Scotty and Captain Kirk), health information will be a worldwide web.
Mayor players are diving into this trillion dollar business.Health information will need to be accessible, and blockchain can be used to guard all interaction between systems.
You can find dozens of documents which handle about this.
Blockchain is a service that supplies functionality such as: non-repudiation, trust between parties in the public domain.
These functionalities can be achieved using existing technology.
In addition health is not something that takes place in the public domain.
There are not many things in healthcare that need anonymous transaction services that banks, notary public, provide.
Healthcare is highly personal.
In the Netherlands Nictiz is busy with it.
For example read this (sorry, only Dutch)
https://www.nictiz.nl/SiteCollectionDocuments/Whitepapers/Blockchain_in_de_zorg.pdf
NICTIZ sees some application of Blockchains at the IT-Infrastructure level: authentication, authorisation, and Access control.
OpenEHR is not a specification at the IT-Infrastructure level.
This is more or less my opinion at the moment as well.
What openEHR has as an underlying data management paradigm is distributed version control - each EHR is like a little git repo. This is no longer new or interesting (in fact, I was exposed to it from 1988, so really not new), but it's just as applicable today as it was then. Re-doing all that in blockchain seems sort of pointless. Yes, health systems can be hacked, but mainly to break privacy, not to fake transactions. Not what blockchain was designed for (and it's more or less the opposite regarding privacy).
- thomas