Increasing EHR Security Using Blockchain.
Velibor Bozic
HoW blockchain can increase security oF EHR
Blockchain technology can increase security of electronic health records (EHR) by providing a tamper-proof, decentralized system for storing and sharing data. Because each block in a blockchain is linked to the previous one, it is virtually impossible to alter or delete any information without it being detected. Additionally, blockchain technology allows for secure, encrypted sharing of EHRs between authorized parties, such as healthcare providers and patients. This can improve the efficiency and accessibility of medical care, while also protecting sensitive personal health information from unauthorized access or breaches.
While I see that the transaction for allowing access to the health record a plus, the issue of privacy in the blockchain for me still represents a considerable risk. In addition, due to the distributed infrastructure, who takes responsibility if there are leaks? While the blockchain is excellent in terms of transparency for transaction auditing, the system was not designed bottoms up for privacy of information (anonymity of the transaction is not the same as privacy of information stored in the blockchain).
Has someone done analysis at the protocol level (e.g. CSP, etc.) to verify this? That is, in terms of compromise at the key level of data storage. I have not found any. If so, let me know
I think this is a fascinating area and well worth exploring !
It's difficult to see this applied to a healthcare environment for healthcare records because healthcare records tend to be locked in to an EHR which maintains its own internal proprietary Registry or Index. EHRs are 'mistrustful' of importing external patients' records data - Blockchain controlled patient data could provide a more Trusted source for import, but most EHR companies are way off this level of technological thinking.
The Secure (tamper-proof) aspects of Blockchain are not the main purpose of Blockchain. They are a side effect of Blockchain being developed for its main purpose, a Distributed Registry or Index. To make a Registry that is linked but distributed, there has to be a tamper proof mechanism to maintain the integrity of the Index, hence Blockchain.
In a healthcare setting, there are implementations of shared health information call Healthcare Interoperability Exchanges.
These always maintain some kind of central Registry or Index of the patient information held in various systems (Repositories) in all the participating systems on this Exchange or Network. [following a pub/sub model, like the IHE open standards implementations for example]
In such a HIE, I could imagine a distributed index (blockchain) and I could imagine it bringing some benefits for implementation. My concern would be the ability to get hold of up-to-date information. Both Blockchain and a central registry model have challenges here, and maybe I don't know enough about Blockchain, but I would have concerns about all the latest updates to a patient's record being available through a distributed index.
On the Blockchain side effect of security/privacy in healthcare data. Existing standards (like IHE) have nuanced data access rules - being able to treat, for example, sexual health or mental health data in a more private way than general healthcare information in a person’s record. I am not sure this is as easily implementable in Blockchain; blocking access to a sensitive record but allowing a "break the glass" functionality to access the data in an emergency, for example. The interpretation of "who is allowed to break the glass" and how it is audited may vary in a blockchain environment whereas with a central Registry and centralised privacy consent management this is much easier to do (even though it still means all participating systems have to implement recognisable/standardised roles to effectively implement a network wide RBAC).
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