Is MedRec architecture maintainable over time?
EHR source systems must continually evolve and Care Providers replace these systems over time. This seems to been intentionally made difficult by using a SQL Query as the stable identifier of a record. The verification mechanism then assumes that the data in the response from the database will stay consistently verifiable over time. Why has maintainability and evolution of EHR source systems in this proposed reference architecture been left unaddressed? Maintainability and evolution is not even mentioned in the future work section. How would MedRec ever cope with evolving database models and replacement of one database model with another? While this is a very interesting area of research I am missing these very basic considerations.
Coming from the healthcare field, I can associate with the vision and pain points. Is there an accompanying working model of the solution?
Research framework on GitHub
is MedRec research framework released on GitHub? I am really interested in decentralized record management system to handle EHRs using block-chain technology
Will this be released in 2017?
Kudos to a great value model! User Experience (UX) design is a formidable obstacle to maturing blockchain from a pure technology play to the consumers in healthcare and life science markets. More at http://bit.ly/2nwF8R2
How can a user have control if the raw data is still on the provider's infrastructure? If the data is not on the blockchain it will not enjoy the benefits of the blockchain itself (which then becomes useless). With analogy to Bitcoin, as long as I keep my bitcoins in the blockchain I am fine. When I buy a car with those bitcoins, that property is no longer protected by the blockchain. Therefore there is no need to use blockchain for a timestamp or permission policies. Blockchain makes sense when resources are scarse and in those cases in which the assets of a peer affect the assets of others (currencies have this property). I don't see this happening in EHR. After reading the whitepaper at https://www.healthit.gov/sites/default/files/5-56-onc_blockchainchallenge_mitwhitepaper.pdf I also have some technical notes. I will just mention one. When user sends an authenticated query to Gatekeeper it verifies that raw data has not been tampered by passing a hash in the query. This works as long as nobody else added a new record in the same database where the query is executed. Needless to say that this is not feasible in practice, as there is no way to distinguish if provider added some new records or changed existing ones from a hash.
This has been done already for several clinical trials. You can view about 25,000 to 50,000 impressions per day here https://metrognomo.com/heatmap/ and the press background March 2016 https://metrognomo.com/news/#press
Proof Of Work
Inasmuch as MedRec is a "permissioned" blockchain, why not use a simpler Proof Of Stake format?
Discussion on Jun 02, 2016
As an elderly patient with lots of healthcare providers I have long recognized and voiced to providers that a system such as this is needed. If you need a test dummy, I would be glad to help. Skimming through the medrec description a couple of ideas occurred to me: 1. Ability to eliminate duplicate tests thus reducing costs to patient, medicare, insurance etc. 2. Allow for future expansion of adding AI to examine a patient's medical records to assist in diagnosis and provide alerts to patient and Dr.
I agree this is some super interesting research, and definetly something the worlds medical systems need. Just in reference to your 1st thought about duplicate tests, that would be great - but the reason tests are duped is liability. If instution A trusts institution B, and something goes wrong, A is still liable for not doing the test themselves. Cryptography wont change that.