Reimagining Health Data Exchange: An Application Programming Interface–Enabled Roadmap for India

Balsari, Satchit; Fortenko, Alexander; Blaya, Joaquín A.; Gropper, Adrian; Jayaram, Malavika; Matthan, Rahul; Sahasranam, Ram; Shankar, Mark; Sarbadhikari, Suptendra Nath; Bierer, Barbara E.; Mandl, Kenneth D.; Mehendale, Sanjay; Khanna, Tarun

doi:10.2196/10725

Cited by 39 publications

(26 citation statements)

References 45 publications

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“…In the absence of an existing digital health records infrastructure, innovative approaches to HIE are being considered, such as blockchain-mediated personal health records linked to the national ID scheme [42]. Similar innovations are also being proposed elsewhere for supporting HIE in decentralized health systems [43].…”

Section: Discussionmentioning

confidence: 99%

Status of health information exchange: a comparison of six countries

Payne¹,

Lovis²,

Gutteridge³

et al. 2019

Journal of Global Health

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BackgroundHealth information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions.MethodsFor each of the countries represented – China, England, India, Scotland, Switzerland, and the United States – we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange.ResultsThe countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality.ConclusionsAlthough the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.

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Section: Discussionmentioning

confidence: 99%

Status of health information exchange: a comparison of six countries

Payne¹,

Lovis²,

Gutteridge³

et al. 2019

Journal of Global Health

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“…Ichikawa et al [34] developed a mHealth system using a mobile phone app that enables a patient-provider exchange of information but for the particular goal of insomnia cognitive behavioral therapy. Balsari et al [35] proposed a use case leveraging the high mobile phone penetration and availability of unique ID systems in India to facilitate health data exchange between more than 500 million Indian citizens and their providers.…”

Section: Discussionmentioning

confidence: 99%

Designing a Distributed Ledger Technology System for Interoperable and General Data Protection Regulation–Compliant Health Data Exchange: A Use Case in Blood Glucose Data

Hawig¹,

Zhou²,

Fuhrhop³

et al. 2019

J Med Internet Res

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Background Distributed ledger technology (DLT) holds great potential to improve health information exchange. However, the immutable and transparent character of this technology may conflict with data privacy regulations and data processing best practices. Objective The aim of this paper is to develop a proof-of-concept system for immutable, interoperable, and General Data Protection Regulation (GDPR)–compliant exchange of blood glucose data. Methods Given that there is no ideal design for a DLT-based patient-provider data exchange solution, we proposed two different variations for our proof-of-concept system. One design was based purely on the public IOTA distributed ledger (a directed acyclic graph-based DLT) and the second used the same public IOTA ledger in combination with a private InterPlanetary File System (IPFS) cluster. Both designs were assessed according to (1) data reversal risk, (2) data linkability risks, (3) processing time, (4) file size compatibility, and (5) overall system complexity. Results The public IOTA design slightly increased the risk of personal data linkability, had an overall low processing time (requiring mean 6.1, SD 1.9 seconds to upload one blood glucose data sample into the DLT), and was relatively simple to implement. The combination of the public IOTA with a private IPFS cluster minimized both reversal and linkability risks, allowed for the exchange of large files (3 months of blood glucose data were uploaded into the DLT in mean 38.1, SD 13.4 seconds), but involved a relatively higher setup complexity. Conclusions For the specific use case of blood glucose explored in this study, both designs presented a suitable performance in enabling the interoperable exchange of data between patients and providers. Additionally, both systems were designed considering the latest guidelines on personal data processing, thereby maximizing the alignment with recent GDPR requirements. For future works, these results suggest that the conflict between DLT and data privacy regulations can be addressed if careful considerations are made regarding the use case and the design of the data exchange system.

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“…Beyond patient-centric applications, other blockchain solutions have been presented in a health care setting including supply chain management [1,12,17,30-32], clinical research and data monetization [14,16,33-36], medical and research fraud detection [34,35,37], public health surveillance [13,18,20,38], and managing internet of (healthy) things [12,39-43].…”

Section: Introductionmentioning

confidence: 99%

A Blockchain Framework for Patient-Centered Health Records and Exchange (HealthChain): Evaluation and Proof-of-Concept Study

Hylock¹,

Zeng²

2019

J Med Internet Res

122

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Background Blockchain has the potential to disrupt the current modes of patient data access, accumulation, contribution, exchange, and control. Using interoperability standards, smart contracts, and cryptographic identities, patients can securely exchange data with providers and regulate access. The resulting comprehensive, longitudinal medical records can significantly improve the cost and quality of patient care for individuals and populations alike. Objective This work presents HealthChain, a novel patient-centered blockchain framework. The intent is to bolster patient engagement, data curation, and regulated dissemination of accumulated information in a secure, interoperable environment. A mixed-block blockchain is proposed to support immutable logging and redactable patient blocks. Patient data are generated and exchanged through Health Level-7 Fast Healthcare Interoperability Resources, allowing seamless transfer with compliant systems. In addition, patients receive cryptographic identities in the form of public and private key pairs. Public keys are stored in the blockchain and are suitable for securing and verifying transactions. Furthermore, the envisaged system uses proxy re-encryption (PRE) to share information through revocable, smart contracts, ensuring the preservation of privacy and confidentiality. Finally, several PRE improvements are offered to enhance performance and security. Methods The framework was formulated to address key barriers to blockchain adoption in health care, namely, information security, interoperability, data integrity, identity validation, and scalability. It supports 16 configurations through the manipulation of 4 modes. An open-source, proof-of-concept tool was developed to evaluate the performance of the novel patient block components and system configurations. To demonstrate the utility of the proposed framework and evaluate resource consumption, extensive testing was performed on each of the 16 configurations over a variety of scenarios involving a variable number of existing and imported records. Results The results indicate several clear high-performing, low-bandwidth configurations, although they are not the strongest cryptographically. Of the strongest models, one’s anticipated cumulative record size is shown to influence the selection. Although the most efficient algorithm is ultimately user specific, Advanced Encryption Standard–encrypted data with static keys, incremental server storage, and no additional server-side encryption are the fastest and least bandwidth intensive, whereas proxy re-encrypted data with dynamic keys, incremental server storage, and additional server-side encryption are the best performing of the strongest configurations. Conclusions Blockchain is a potent and viable technology for patient-centered access to and exchange of health information. By integrating a structured, interoperable design with patient-accumulated and generated data shared through smart contracts into a universally accessible blockchain, HealthChain presents patients and providers with access to consistent and comprehensive medical records. Challenges addressed include data security, interoperability, block storage, and patient-administered data access, with several configurations emerging for further consideration regarding speed and security.

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Reimagining Health Data Exchange: An Application Programming Interface–Enabled Roadmap for India

Cited by 39 publications

References 45 publications

Status of health information exchange: a comparison of six countries

Status of health information exchange: a comparison of six countries

Designing a Distributed Ledger Technology System for Interoperable and General Data Protection Regulation–Compliant Health Data Exchange: A Use Case in Blood Glucose Data

A Blockchain Framework for Patient-Centered Health Records and Exchange (HealthChain): Evaluation and Proof-of-Concept Study

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