Healthc Inform Res.  2020 Jan;26(1):3-12. 10.4258/hir.2020.26.1.3.

Application of Blockchain to Maintaining Patient Records in Electronic Health Record for Enhanced Privacy, Scalability, and Availability

• Tith D
• Lee JS
• Suzuki H
• Wijesundara WMAB
• Taira N
• Obi T
• Ohyama N

• KMID: 2469395
• DOI: http://doi.org/10.4258/hir.2020.26.1.3

Abstract

OBJECTIVES
Electronic Health Record (EHR) systems are increasingly used as an effective method to share patients' records among different hospitals. However, it is still a challenge to access scattered patient data through multiple EHRs. Our goal is to build a system to access patient records easily among EHRs without relying on a centralized supervisory system.
METHODS
We apply consortium blockchain to compose a distributed system using Hyperledger Fabric incorporating existent EHRs. Peer nodes hold the same ledger on which the address of a patient record in an EHR is written. Individual patients are identified by unique certificates issued by a local certificate authorities that collaborate with each other in a channel of the network. To protect a patient's privacy, we use a proxy re-encryption scheme when the data are transferred. We designed and implemented various chaincodes to handle business logic agreed by member organizations of the network.
RESULTS
We developed a prototype system to implement our concept and tested its performance including chaincode logic. The results demonstrated that our system can be used by doctors to find patient's records and verify patient's consent on access to the data. Patients also can seamlessly receive their past records from other hospitals. The access log is stored transparently and immutably in the ledger that is used for auditing purpose.
CONCLUSIONS
Our system is feasible and flexible with scalability and availability in adapting to existing EHRs for strengthening security and privacy in managing patient records. Our research is expected to provide an effective method to integrate dispersed patient records among medical institutions.

Keyword

Health Information Exchanges; Electronic Health Records; Patient Data Privacy; Computer Security; Decentralization

MeSH Terms

Commerce
Computer Communication Networks
Computer Security
Confidentiality
Electronic Health Records*
Health Information Exchange
Humans
Logic
Methods
Politics
Privacy*
Proxy

Figure

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  Figure 1 Channel of network among medical institutions with the same ledger. EHR: Electronic Health Record.

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  Figure 2 Proxy re-encryption scheme.

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  Figure 3 First visit to a hospital.

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  Figure 4 Uploading record with metadata and consent access. EHR: Electronic Health Record.

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  Figure 5 Requesting patient's records. CA: certificate authority, EHR: Electronic Health Record.

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