Bitcoin is since a few weeks prohibited in China but it seems hard to kill.
But still, I don't think the use of blockchain in healthcare can be compared to the use of blockchain in currency, because, bitcoins is about getting rich by creating as many as possible, while in healthcare they exist to facilitate processes, and the number of processes create the demand, not the wish to get rich.
Another thing which came to mind, electricity is expensive because it needs to be created near the place where it is going to be used, or it needs to be transported. But blockchains for any purpose can be created on any place on earth, also on places where energy is almost for free. For example, windmills on top of the Himalaya, or solar cells in the middle of the Sahara. Just transport the bitcoins, no need to pollute the world very much.
I am not really into that technical knowledge like radio-modulation or laser-light modulation. But when they communicate with the Hubble telescope, transmitting simple numbers over a few hundred kilometers will not be a big problem.
In the healthcare related blockchain ideas or prototype implementations I have heard about so far something different than proof of work is used, for example proof of authority. That has other drawbacks and challenges, but it does not suffer from the same power consumption problems.
Also any public healthcare related blockchain has interesting privacy issues that will need to be solved.
In the healthcare related blockchain ideas or prototype implementations I
have heard about so far something different than proof of work is used, for
example proof of authority. That has other drawbacks and challenges, but it
does not suffer from the same power consumption problems.
that's true. But I don't see s sweet spot there; either you end up falling
back to a central authority after all - in which case you might as well
just trust the central authority and design a more efficient solution, or
you have something that's less secure - but doesn't - as far as I can
figure out - have less of a reason to need security. The one possible
exception I've seen, which I've seen in production, is closed trading
schemes around tracking payments between a group of entities.
Bitcoin, f.e. is about billions of dollars without central authority, that is one of the reasons the Chinese government prohibited the creation (although they do not admit this real reason)
Agreed, but a third party that would just be in charge of making certain that the blockchain is unaltered has nothing to do with the business involved. It is a technical trusted party, and there is no true reason it should be expensive (for example, it could publish the hash of the blockchain at every growing stages, so that anybody can check if currently published blockchain is trustable).
It has nothing in common with a Ministry of Health or any other “bag of technocrats” (just kidding, of course).
Agreed, but a third party that would just be in charge of making certain
that the blockchain is unaltered has nothing to do with the business
involved. It is a technical trusted party, and there is no true reason it
should be expensive (for example, it could publish the hash of the
blockchain at every growing stages, so that anybody can check if currently
published blockchain is trustable).
It has nothing in common with a Ministry of Health or any other "bag of
technocrats" (just kidding, of course).
Doesn't it? I suspect that might be true in a theoretical technical sense,
but I expect that it will prove not to be correct in the real world
One problem with blockchain is that people think every blockchain is secure, anonymous and decentralized – but that really depends on the specific implementation.
You can probably still create a proof of something-that-is-not-work-or-space that is reasonably decentralized, given you have enough independent parties who can authorize blocks, a mechanism to decide how to trust new authorizing parties and a good tamper-proof protocol including for example strict rate limiting.
But the very nature of storing healthcare related data in a public blockchain seems very tricky to me anyway – almost any implementation would need to be able to handle attacks where you link multiple pieces of data to the same person or party without having explicit permission to do so.
Regards,
well if the physician included in his/her notes a mention of the original event, or better, it was included in a FEEDER_AUDIT, the versioning in the openEHR system will make sure there is medico-legal protection. It is very unlikely that a physician would record a decision (e.g. to prescribe some drug) without mentioning why. So unless you are talking about the openEHR system being actively hacked, I don’t think this is a real use case. If we are talking about the openEHR versioning being hacked, then a) they had to hack RAID 10 storage, DB persistence mirroring, daily backups, b) the data centre has singificant security, c) some security analysis will have been made in advance (it will, won’t it?!), and depending on the perceived threat, there may be e.g. hashing + notary, or signed hashes + notary, which requires the hackers to be of a superior variety. It’s a fair bit of work to invisibly hack a properly implemented versioned DB implementation within a secure facility, which is what is needed for a medico-legal claim based on data to fail. ok, now that’s privacy, so we are talking data theft, not integrity or non-repudiation of authorship. these are I agree, important questions, and we’ve tried to cover some of it with openEHR e.g. via , URI datatype, and more recently some thinking in a being considered for the RM (I’ve added a note to this to cover the requirement to safely refer to / ?copy content from external systems). We need to consider these kind of reference questions more carefully and provide more comprehensive solutions for sure. - thomas
No one ever hacks a RAID-system, they hack the software. The RAID system is to the software like a single disk, if you remove data from software, then the RAID system will remove it too, it follows the software. The DB persistence mirroring is the same story. Daily backups are never rolled back (only in disaster scenario), because you will lose all newly entered data. A friend, a journalist was taking track of all illegal data-leaks in medical context, he has done that for over ten years. It must have been millions of patients whose data are leaked, stolen notebooks with copies of databases, lost USB-sticks, hacked accounts, every day there is something. It happens in the best secured organizations like the army. A container full with paper-patient-dossiers was standing on the street in a big city. Harddisks are not always cleaned up when sold to second hand computer-shops. I once got (so was said) a brand new server-hard-disk from HP-reseller, it wasn’t new, there were data on it. Mostly this news is from the USA because there they is the obligation to report data leaks to the public. In the Netherlands this is not so, and guess who is against such a law? Yes, that is, and maybe it is just paranoia, everybody has the right to be paranoid. Special in small communities data can leak very easy. Social hacking, you can call that. Happens all the time. But that kind of leaking cannot always be avoided with blockchain, unless the leaking GP is looking at someone else his system over a secured logging communication-network. Then it should be that the looking into data will be in a transaction, because it is interchanging medical data, which must guaranteed to be complete, unaltered and logged at receiver and sender. It is a very complicated subject, and I did not expect any action taken on my initial question, yesterday morning. But there was discussion, I also learned from it. Huge ICT companies are implementing blockchain-applications, and the medical world will for sure be one of the targets. They are ready to implement and sell it. They will convince governments that it is needed. In the Netherlands, Nictiz is on their side. Nictiz is the only information-source for the government. My question is, can this be transparent, (like RAID 10 is to a system), or is there an architectural change needed on the logical layers? Or is there an architectural layer desirable? Do medical software architects want to influence decisions? Then they need to take positions. It is not something for today or tomorrow, or the day after tomorrow. But next year? In two years? IBM is selling blockchain-technology: Today I was reading about Mastercard going to use blockchain, they patented an own implementation (sorry, in Dutch) The patent Best regards Bert
A blockchain[1][2][3] – originally block chain[4][5] – is a continuously growing list of records, called blocks, which are linked and secured using cryptography.[1][6] Each block typically contains a hash pointer as a link to a previous block,[6] a timestamp and transaction data.[7] By design, blockchains are inherently resistant to modification of the data. A blockchain can serve as “an open, distributed ledger that can record transactions between two parties efficiently and in a verifiable and permanent way.”[8][not in citation given (See discussion.)] For use as a distributed ledger, a blockchain is typically managed by a peer-to-peer network collectively adhering to a protocol for validating new blocks. Once recorded, the data in any given block cannot be altered retroactively without the alteration of all subsequent blocks, which requires collusion of the network majority.
What is Blockchain offering?
Bringing data from a to b?
Storing data?
Securing data?
Preventing privacy incidents?
Taking care of non-repudiation?
Taking care of data integrity?
Play a role in logging?
Will it prevent hacking of PC’s, Servers?
and other attacks such social hacking, pasword sniffing, etc.?
At best it serves a role in: non-repudiation, data integrity and logging (access control lists) without the need of a trusted third party service.
But one has to rely on safe/secure IT-systems that make use of it.
It takes care of a non-health related issue; it takes care of a generic legal issue.
Bye the way. NICTIZ’ opinion is:
Certainly it (blockchain) can not be deployed and replace in healthcare the present “proven technology"
Het kan zeker nog niet worden ingezet voor vervanging van de huidige “proven technology” in de zorg
It is in the hype-phase.
Many of the potential advantages will have to be proven.
Dear Gerard, Nictiz published hundreds of pages about blockchain. So if it is a hype (which it is), then Nictiz is playing an important role in that.
You cannot summarize those hundreds of pages to a few words and then state that that reflects the opinion of Nictiz. Blockchain is a comprehensive subject.
In paragraph 2.1 is mentioned an advisoryboard from the ministry of health (VWS) about blockchain, and it is said that smart contracts and also other applications of blockchain are possible and maybe desirable. Please read also page 13 which has an summarized overview of arguments pro and contra blockchain in specific applications.
Again, I don’t know on which of level the logical architecture blockchain will become important, but if it does, it is very likely that it will be, like Thomas Beale also writes, in the part of Feeder-Audit, where information transactions between systems are worked out.
I mentioned yesterday that it was also possible to secure chains of events in the Statemachine, or the extended counterpart which Thomas described shrt time ago, especially if more healthcare institutions are involved in those serie of events, which is very often the case.
A lot may have to do with the costs of the implementation and if there are cheaper variants possible. High volume expert Mastercard thinks that this is indeed possible.
