I think we are heading an era where it can be impossible to tell where
from and/or when data are received /created and which event created the
data or made the data cause to interchange when the data do not tell us
themselves on an accountable way. For that we need an open notary-system
which does not rely on third parties (which would make it to expensive).
There are not many kinds of personal data which will be interchanged so
much or are created in chains of events (context) as medical data.
I see that is quite a challenge to arrange such a system, but we will
need it to guarantee professional and medical safety and also privacy.
Maybe I am wrong, but I think blockchain may be a way to help us with that.
I have not seen in this discussion many people acknowledging these near
future problems which can effect clinicians (in accountability) and
patients (in health-safety).
How about a clinician taking a fatal decision on base of an event
described on another system and that other system changed its contents
afterwards?
How about a patient who discovers its employer has knowledge of private
medical data? People often think about psychiatric circumstances, but it
can be other things in this time of revival of religions, f.e. a woman
who hides the fact she has had an abortion and is now teaching on a
christian school.
Also interesting in this discussion is how to handle deletion of medical
data (the patients right to be forgotten).
Can it be that data refer to data on other systems, or may they only
refer to data on the same system, copies of data from other systems?
Do these copies need some accountable reference to where they come from?
These are problems which will not be solved easy. But they need to be
solved by system builders which will advise the lawmakers.
Bert
On 14-11-17 11:51, Philippe Ameline wrote:
Hi to all,
A Blockchain is a public (or at least shared) digital notary.
The easiest (hence probably the more meaningful) use case is to disrupt
existing notary systems (disrupt in its accurate definition: deliver
something that is initially less powerful, but evolves greatly faster).
A Blockchain can come with or without a trusted third party. It seems to
me (in such a domain, I know very few people with a firm opinion) that
transactions are more expensive without a third party, because you need
to make the process of adding a new block "expensive enough" in order to
make sure that the one doing it can not deploy enough computing power to
hack the existing blocks during the process.
However, in real estate, for example, the price of a Blockchain
transaction, even if we take the cost of a Bitcoin transaction as a
reference, remains far below what we have to pay to register our ownership.
In health, I am always amazed by the level of ingenuity of some actors
(do you know of any innovation that has not been qualified as
"applicable in health"?) and, in contrast, the global archaism of the
domain at large.
I recently read a paper about a FIHR conference that said that all this
is fantastic, but that, in current times, it could be nice not to only
exchange information "about the patient" ;-)
So... yes, the Blockchain is super trendy... yes there are probably many
smart ways to use it in health... but maybe, before considering the use
of such marvelous pieces of technology, it could be wondered if the
medical domain is not fully missing its inclusion in the information
society.
Best,
Philippe
Le 13/11/2017 à 14:35, Thomas Beale a écrit :
There may be applications such as 'digital notary' that blockchain
might be useful for, which is a trusted third party notary that
accumulates signed hashes of content transactions to the main EHR; if
it is thought that the EHR was hacked or integrity was in question,
the digital notary can be used to check. There was even a gNotary
project in gnu health years ago. But as Grahame says, protecting
against transaction errors / hacking isn't a burning problem to date.
However, if you want to accumulate the whole contents of transactions,
blockchain is unlikely to be be scalable.
Maybe this will change and blockchain will find use there.
- thomas
On 13/11/2017 13:15, Bert Verhees wrote:
On 13-11-17 14:02, Thomas Beale wrote:
...
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).
It is not about hacking why blockchain is interesting, although, that
can happen too. But it is about having trustworthy computing without
a trusted third party. Not only protecting against bad intentions but
also against errors, for example, system which not run synchronous or
have date/time(zone) not well configured. Not a trusted party ensures
delivery and time of delivery and contents of delivery, but
blockchain as a mechanism does.
I have given already a few examples.
Remember, computers make no errors, but people do, and it are people
which configure computers and use them, and their responsibility must
be able to transparently replayed afterwards.
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