MedRec: Medical Data Management on the Blockchain
Electronic Medical Records (EMRs) crave innovation. Years of regulation have stied tech development in medical data management, while an array of incompatible back end systems and fragmented data trails limit patients' ability to engage with their medical history. We demonstrate MedRec as a solution tuned to the needs of patients, the treatment community, and medical researchers. MedRec applies novel, blockchain smart contracts to create a decentralized content management system for your healthcare data, across providers. The MedRec authentication log governs medical record access, while providing means for auditability and data sharing. A modular design integrates with providers' existing, local data storage solutions, enabling interoperability and making our system convenient and adaptable. As a key feature of our work, we engage the medical research community with an integral MedRec: Medical Data Management on the Blockchain Ariel Ekblaw, Asaf Azaria Follow Pub 14 Content 5 Versions 7 Contributors 1 Journal Search PubPub Login Signup 2/27/2017 MedRec: Medical Data Management on the Blockchain PubPub https:/www.pubpub.org/pub/medrec 2/16 role in the protocol. Medical researchers provide the "mining" necessary to secure and sustain the authentication log on a private, Ethereum network, in return for privacypreserving, medical metadata in the form of "transaction fees." Our Motivation Approach From fragmented access to comprehensive access Patients interact with a staggering number of health care providers through the course of their lives from pediatrician, to university physician, dentist, employer health plan provider, specialists, and more. At each stage, they leave data scattered across a particular jurisdiction's system [1] This leads to a fragmented data trail and decaying ease of access, as providers often retain primary data stewardship (either via default practices or explicit legal provisions in over 21 states) [2] Our MedRec prototype enables patients with one stop shop access to their medical history across multiple providers: smart contracts on an Ethereum blockchain [2] aggregate data pointers (references to medical records that are stored elsewhere) into "patient provider relationships." These contract data structures 2/27/2017 MedRec: Medical Data Management on the Blockchain PubPub https:/www.pubpub.org/pub/medrec 3/16 are stored on the blockchain and associate references to disparate medical data with ownership and viewership permissions and record retrieval location. This provides an immutable data lifecycle log, enabling later auditing. We include a cryptographic hash of the record in the smart contract to establish a baseline of the original content and thus provide a check against content tampering. The raw medical record content is never stored on the blockchain, but rather kept securely in providers' existing data storage infrastructure. MedRec facilitates reviewing, sharing and posting of new records via a exible user interface, designed to reect best practices from the Blue Button health record competition [1] We abstract away the blockchain technology to focus on usability for the medical record use case. The interface includes a notications system to alert users when a new record has been posted on their behalf or shared with them. From data rigidity to data sharing Interoperability challenges between dierent provider systems pose signicant barriers to eective data sharing. Patients face hurdles in authorizing data exchange (with other consulting physicians or even family members) due to the lack of a common interface or standard system that orchestrates record access across databases [1] MedRec provides streamlined data sharing functionality by updating viewership 2/27/2017 MedRec: Medical Data Management on the Blockchain PubPub https:/www.pubpub.org/pub/medrec 4/16 permissions on the relevant data pointers. With pointers to patient data aggregated in smart contracts on the blockchain, we can oer a single, common interface where patients chose when, and with whom, they share their data. From obscurity to clarity While most valuable to the patient and provider, medical records also prove critical for research. A recent report from the Oce of the National Coordinator for Health Information Technology emphasizes that biomedical and public health researchers "require the ability to analyze information from many sources in order to identify public health risks, develop new treatments and cures, and enable precision medicine" [1] Though some data trickles through to researchers from clinical studies, surveys and teaching hospitals, we note a growing interest among patients, care providers and regulatory bodies to responsibly share more data, and thus enable better care for others [1] With MedRec, we incentivize medical researchers and other healthcare stakeholders to participate in the blockchain network as "miners" (see Appendix: Bitcoin Basics for more on mining and the fundamentals of blockchain) These researchers can now obtain greater clarity in their investigations by earning census level, anonymized metadata in return for contributing the computational resources that sustain the network. MedRec enables the emergence of data economics between data consumer and data producer, as 2/27/2017 MedRec: Medical Data Management on the Blockchain PubPub https:/www.pubpub.org/pub/medrec 5/16 the system supplies big data to empower researchers while engaging patients and providers in the choice of how much metadata to release. Designing for patient agency When designing new systems to overcome current EMR challenges, we must prioritize patient agency. Patients benet from a holistic, transparent view of their medical history, and in the age of online banking and social media, patients are increasingly willing, able and desirous of managing their data on the web and on the go [4] MedRec restores patient agency by empowering users with a focal point for access and review of their medical history, and an easy mechanism for sharing their data across medical jurisdictions. Patients can authorize a new doctor to review their record and obtain a second opinion, or grant viewership rights to a guardian they trust. Grandparents can seamlessly share medical data with their families, to reduce the mystery of family health history. Furthermore, the authorization log persists in the distributed network, providing crucial back up and restore functionality. Patients can leave and rejoin the system multiple times, for arbitrary periods, and regain access to their history by downloading the latest blockchain from the network. Summary of MedRec contributions: 2/27/2017 MedRec: Medical Data Management on the Blockchain PubPub https:/www.pubpub.org/pub/medrec 6/16 Comprehensive, immutable log of authentication permissions for ease of data access and auditing Data sharing authorization, with oblockchain content syncing Interoperability with providers' existing data storage infrastructure Blockchain mining incentives for medical researchers via anonymized metadata rewards Custom API for handling smart contract content and posting to a private, Ethereum blockchain Intuitively designed user interface for patient and provider use