Decentralised provenance for healthcare data

Abstract

Objective: the creation and exchange of patients’ Electronic Healthcare Recordshave developed significantly in the last decade. Patients’ records are howeverdistributed in data silos across multiple healthcare facilities, posing technicaland clinical challenges that may endanger patients’ safety. Current healthcaresharing systems ensure interoperability of patients’ records across facilities, butthey have limits in presenting doctors with the clinical context of the data in therecords. We design and implement a platform for managing provenance track-ing of Electronic Healthcare Records based on blockchain technology, compliantwith the latest healthcare standards and following the patient-informed consentpreferences.

Methods: the platform leverages two pillars: the use of international standards such as Integrating the Healthcare Enterprise (IHE), Health Level Seven In-ternational (HL7) and Fast Healthcare Interoperability Resources (FHIR) toachieve interoperability, and the use of a provenance creation process thatby-design, avoids personal data storage within the blockchain. The platformconsists of: (1) a smart contract implemented within the Hyperledger Fabricblockchain that manages provenance according to the W3C PROV for medical document in standardised formats (e.g., a CDA document, a FHIR resource, aDICOM study, etc.); (2) a Java Proxy that intercepts all the document submis-sions and retrievals for which provenance shall be evaluated; (3) a service usedto retrieve the PROV document.

Results: we integrated our decentralised platform with the SpiritEHR engine,an enterprise-grade healthcare system, and we stored and retrieved the avail-able documents in the Mandel’s sample CDA repository1, which contained noprotected health information. Using a cloud-based blockchain solution, we ob-served that the overhead added to the typical processing time of reading andwriting medical data is in the order of milliseconds. Moreover, the integrationof the Proxy at the level of exchanged messages in EHR systems allows trans-parent usage of provenance data in multiple health computing domains such asdecision making, data reconciliation, and patient consent auditing.

Conclusions: by using international healthcare standards and a cloud-basedblockchain deployment, we delivered a solution that can manage provenance ofpatients’ records via transparent integration within the routine operations onhealthcare data.

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