On 13/11/2017 12:32, Grahame Grieve wrote:
I am sceptical of most use cases of block chain outside payments
witnessing in some limited trading schemes. There are 2 inter-related
problems.
- block chain is a very inefficient solution to a problem that largely
does not exist in healthcare: untamperable evidence that something
happened, in the context of not having any trustable governor. In
almost all cases, we actually want to be able to tamper with the
record - except the audit trail. And/or suppress data from being
visible except to a few authorised parties. For the audit trail, the
average institution generates more data per day than block chain
presently holds - we are talking vast amounts of data
- the inefficiency is considerable - full block chain requires some
benefit to the miners - and in any volume of data, the price is
considerable (e.g. blockchain consumes more power than nigeria, I read
this week); that is not evident in any scheme I've seen, but schemes
that have restricted mining loads require restricted attack surfaces,
and I don't believe that there's a sweet spot there in healthcare
There are some interesting use cases around selective sharing data for
research using active blockchains (e.g. ethereum) but by and large
these seem outside the scope of records and EHRs to me
This is more or less my opinion at the moment as well.
What openEHR has as an underlying data management paradigm is
distributed version control - each EHR is like a little git repo. This
is no longer new or interesting (in fact, I was exposed to it from 1988,
so really not new), but it's just as applicable today as it was then.
Re-doing all that in blockchain seems sort of pointless. Yes, health
systems can be hacked, but mainly to break privacy, not to fake
transactions. Not what blockchain was designed for (and it's more or
less the opposite regarding privacy).
- thomas
--
Thomas Beale
Principal, Ars Semantica <http://www.arssemantica.com>
Consultant, ABD Team, Intermountain Healthcare
<https://intermountainhealthcare.org/>
Management Board, Specifications Program Lead, openEHR Foundation
<http://www.openehr.org>
Chartered IT Professional Fellow, BCS, British Computer Society
<http://www.bcs.org/category/6044>
Health IT blog <http://wolandscat.net/> | Culture blog
<http://wolandsothercat.net/>
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