ARBoR: An Identity and Security Solution for Clinical Reporting

Abstract

Motivation : Clinical genome sequencing laboratories return reports containing clinical testing results, signed by an Board Certified clinical geneticist, to the ordering physician. This report is often a pdf, but can also be a physical paper copy or a structured data file. The reports are frequently modified and re-issued, due to changes in variant interpretation or clinical attributes. To precisely track report authenticity we developed ARBoR, an application for tracking the lineage of versioned clinical reports even when they are distributed as pdf or paper copies. ARBoR employs a modified blockchain approach and instead of relying on a computationally intensive consensus mechanism for determining authenticity, we allow supervised and digitally signed writes to an encrypted ledger, which is then exactly replicated to many clients.Results : ARBoR was implemented for clinical reporting in the HGSC-CL Clinical Laboratory, initially as part of the NIH's Electronic Medical Record and Genomics (eMERGE) project. To date we have issued 15,205 versioned clinical reports tracked by ARBoR. This system has provided us with a simple and tamper-proof mechanism for tracking clinical reports with a complicated update history.

Blockchain’s potential to address issues in genomics research and how it is being used today

“…9 Immutability of the blockchain is such that only future blocks at the time of creation can be altered, whether it be in the mining or verification process-in other words, the nodes supporting the blockchain network would recognize any changes in the ledger such as attempts to manipulate a previous block as an entirely different network. 11 Ultimately, these properties provide the framework necessary for a reliable, decentralized network that can securely store data and transaction records. 9 While cryptocurrencies serve a useful medium of exchange, the blockchain technology itself has potential applications in other fields such as education, healthcare, and research.…”

“…11 However, continuous advancements in genetics research require constant reanalysis and consequent updating of existing clinical genomic data reports. 11 With such frequent revisions, there are several concerns that arise: For example, it may be difficult to keep track of the changes and ensure that only the most updated clinical genomic reports are distributed to clinicians and patients. 11 Furthermore, records may be maliciously altered without detection.…”

“…11 With such frequent revisions, there are several concerns that arise: For example, it may be difficult to keep track of the changes and ensure that only the most updated clinical genomic reports are distributed to clinicians and patients. 11 Furthermore, records may be maliciously altered without detection. 11 ARBoR solves these potential issues by storing the data of each single report as a single data block in the ARBoR ledger.…”

“…11 Furthermore, records may be maliciously altered without detection. 11 ARBoR solves these potential issues by storing the data of each single report as a single data block in the ARBoR ledger. 11 When a report is revised, a new block is specifically made to fit and link to the block that contains the data of the previous version of the report.…”

“…11 ARBoR solves these potential issues by storing the data of each single report as a single data block in the ARBoR ledger. 11 When a report is revised, a new block is specifically made to fit and link to the block that contains the data of the previous version of the report. 11 This process ultimately creates a chronological history of record revisions that is easy to validate but difficult to maliciously alter.…”