secure and trustable emr sharing using blockchain: open … · 2018. 6. 19. · 2018. 6. 19. ·...

Secure and Trustable EMR Sharing using Blockchain:

Open Challenges and Lessons Learned

Alevtina Dubovitskaya, Rohit Shukla, Zhigang Xu, Samuel Ryu, Michael Schumacher, Fusheng Wang

Medical data are distributed

https://thedatamap.org/map2013/index.php3

Medical data…

http://www.eu-patient.eu/Members/Weekly-Mailing/eTriks-research-data/

• Sensitive• Distributed

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Medical data…


• Sensitive• Distributed• Heterogeneous & Dynamic

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Medical data…


• Sensitive• Distributed• Heterogeneous & Dynamic• Have to be maintained life-long• Can be required urgently

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Medical data…


• Sensitive• Distributed• Heterogeneous & Dynamic• Have to be maintained life-long• Can be required urgently• Need to be exchanged often

(consent is required)

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Medical data are being digitalized

https://dpconline.org/handbook/organisational-activities/creating-digital-materialshttp://www.scbhrserv.com/medical-record-review.html 8

…but the consents are still paper based!

https://medium.com/wehearthealthliteracy/wanted-plain-language-consent-forms-26557ff9fe1b

…but the consents are still paper based!


• treatment delays,• wasted resources,• increased costs,• lost control over the data.

?

Web app prototypefor patients and doctors

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Patient: My data

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Patient: My data

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Patient: Add permissions

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(1)

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(2)

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Patient: My permissions

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Patient: My permissions

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Doctor: Show available data

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Doctor: Show available data

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Doctor: Download data

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Doctor: Download data

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01010011…

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Who is going to store and manage all these consents/permissions/data?


01010011…

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01010011…

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01010011…

26



01010011…

Single point of trust (and failure)

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Blockchain, What is it?

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Blockchain, what is it?

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Blockchain, what is it?

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How to update the ledger?

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State…


33

State…


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LogicState…


35

LogicState…

State


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Logic…


• Logic/Smart contract – a program that defines functionality of the blockchain applications

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Chaincode (CC):

LogicState…

Who can update the ledger?

• Permissionless: everyone maintaines the ledger and can compete to become the « leader » and add the new block (PoW, PoS, …)

• Permissioned: only predefined set of users maintaines the ledger and participates in the leader election can create and add a new block to the ledger

• Hybrid: predefined set of users is changing

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Who can update the ledger?Who can access the ledger?



– Public: everyone can access the data stored on the ledger– Private: only predefined set of users can access the data stored on the ledger


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Who can update the ledger?Who can access the ledger?



– Public: everyone can access the data stored on the ledger– Private: only predefined set of users can access the data stored on the ledger


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Which one to choose?

Permissionless blockchain

Logic

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Logic

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Leader

Logic

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Logic

Leader

Validator Validator

ValidatorValidator

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• Anonymous (till certain level)• Every node can compete to become a leader• PoW (solving crypto-puzzle) is energy consuming• Transaction fees• Privacy?

Logic

45

Permissioned blockchain

Membership service

Leader

Validator Validator

Validator

Logic Logic

Logic

Logic

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Permissioned (public) blockchain

• Scalable?• Who hosts membership service?• Privacy?

Membership service

Leader

Validator Validator

Validator

Logic Logic

Logic

Logic

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Permissioned (private) blockchain

• Scalable?• Who hosts membership service?• Privacy?

Membership service

…

Leader

Validator Validator

Validator

Logic Logic

Logic

Logic

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…

Leader

Validator Validator

Validator

Hybrid blockchain (validators are changing after certain number of blocks)

Logic Logic

Logic

Logic

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Hybrid blockchain (validators are changing after certain number of blocks)

…

Leader

Validator

Validator • PoW / random choice of validators? • Transaction fees• Privacy?

Validator ValidatorLogic Logic

Logic

Logic

Logic

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Our choice : permissioned private blockchain with chaincode functionality

Validator

Logic

Membership service

…

LogicLogic

Logic

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Healthcare Data(provided by)

Clinical Data Patient Data

Healthcare Data Management

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System Metadata

• Metadata• Permissions

…of…

…for…


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System Metadata


…of…

…for…


Logic

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System Metadata


…of…

…for…


Logic

• Limited storage capabilities • Efficiency?

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System Metadata


…of…

…for…


Logic

• Limited storage capabilities • Efficiency?

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System Metadata


…of…

…for…


Logic

HIPAA Compliant Cloud Storage (CS)

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Validating Node (VN1)


Validating Node (VNN)Chaincode

Chaincode

ChaincodeLogic State

EMR BlockchainNetwork


…

System Overview


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Chaincode


Membership Service (MS)Reg. A ECA TCA TLS-CA

Validating Node (VN2)EMR Blockchain

Network


The National

Practitioner Data Bank

…

System Overview

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Chaincode



Solution User (SU)Patient P

Caregiver C


Network


The National


…

System Overview

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Chaincode


UI Provider (UIP)mobile/web app

Non-Validating Node



Caregiver C


Network


The National


…

System Overview

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Chaincode


UI Provider (UIP)mobile/web app

Non-Validating Node



Caregiver C


Network


The National


…

System Overview

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Open challenges• No legal base on blockchain• Conflict with GDPR “right to be forgotten”

• Emergency access• Risks of the new technology (adoption?)

• Correctness of the chaincode? (*)• Who controls Membership service? (*)• Key management (*)• Usability? (*)

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legal

medical/social

technical



• Correctness of the chaincode? (*)• Who controls Membership service? (*)• Key management (*)• Usability? (*)

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legal

medical/social

technical



• Correctness of the logic of the chaincode? (*)• Who controls Membership service? (*)• Key management (*)• Usability? (*)

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legal

medical/social

technical

Contact and more information: [email protected]

secure and trustable emr sharing using blockchain: open … · 2018. 6. 19. · 2018. 6. 19. ·...

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