Re: Blockchain

[Alexander Garcia Castro]

Following up on the interesting exchange wrt blockchain what I can see is
confusion. When to use blockchain technology? when to go for a distributed
database? when is provenance and time stamping critical but blockchain does
not make sense?

We want to hear about vision of technology, work in progress, critical
views of technology in specific areas and much more.  Our Call for Papers
is clearly on topic for this discussion.

https://datasciencehub.net/content/special-issue-distributed-ledgers-making-
data-science-more-open-transparent-and-accountable

Hopefully OpenEHR may share some interesting light in the use, or the when
not to use, blockchain tech in health care.

On Mon, Nov 13, 2017 at 5:19 PM, Bert Verhees  wrote:

> On 13-11-17 17:09, Thomas Beale wrote:
>
>> I agree, that's an interesting idea. I have not put any thought into it,
>> but it's worth investigating. But we need to be clear on what problem is
>> being solved here. Is it improvements in medico-legal standard of proof, or
>> something else? What is the economic driver, and why are the current
>> mechanisms (signing and versioning) not good enough?
>>
>
> The advantage in legal context is that independent of machines can be
> proven what has happened. A nurse writes down in her app that a patient is
> doing bad, a doctor sees the messages, having it on the screen is also an
> action, and then going to visit the patient, action...
>
> It gets more interesting when more systems are involved because they
> together register a chain of events, and because of the blockchain they can
> relate to each other.
>
>
>
>
>
>> - thomas
>>
>>
>> On 13/11/2017 14:02, Bert Verhees wrote:
>>
>>> Thomas, one  more remark, I remember the task-planning-specification
>>> where you have been working on, and on which you planning to give a
>>> presentation in London soon.
>>>
>>> It is there where I thought there could be an excellent example of
>>> implementation of blockchain. Because it is about a processing model,
>>> state-machine, decisions, how good would it be for a performer to be able
>>> to prove: a decision taken on information or having taken a step, or other
>>> cicrumstances, by implementing the blockchain mechanism?
>>>
>>> That would just be a classical use case for which blockchain was
>>> invented.
>>>
>>
>>
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>> lists.openehr.org
>>
>
>
>
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http://www.usefilm.com/photographer/75943.html
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blockchain

[Alexander Garcia Castro]

Following up on the interesting exchange wrt blockchain what I can see is
confusion. When to use blockchain technology? when to go for a distributed
database? when is provenance and time stamping critical but blockchain does
not make sense?

We want to hear about vision of technology, work in progress, critical
views of technology in specific areas and much more.  Our Call for Papers
is clearly on topic for this discussion.

https://datasciencehub.net/content/special-issue-distributed-ledgers-making-data-science-more-open-transparent-and-accountable

Hopefully OpenEHR may share some interesting light in the use, or the when
not to use, blockchain tech in health care.



-- 
Alexander Garcia
https://www.researchgate.net/profile/Alexander_Garcia
http://www.usefilm.com/photographer/75943.html
http://www.linkedin.com/in/alexgarciac
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Re: Blockchain

[Bert Verhees]

On 13-11-17 17:09, Thomas Beale wrote:
I agree, that's an interesting idea. I have not put any thought into 
it, but it's worth investigating. But we need to be clear on what 
problem is being solved here. Is it improvements in medico-legal 
standard of proof, or something else? What is the economic driver, and 
why are the current mechanisms (signing and versioning) not good enough?


The advantage in legal context is that independent of machines can be 
proven what has happened. A nurse writes down in her app that a patient 
is doing bad, a doctor sees the messages, having it on the screen is 
also an action, and then going to visit the patient, action...


It gets more interesting when more systems are involved because they 
together register a chain of events, and because of the blockchain they 
can relate to each other.






- thomas


On 13/11/2017 14:02, Bert Verhees wrote:
Thomas, one  more remark, I remember the task-planning-specification 
where you have been working on, and on which you planning to give a 
presentation in London soon.


It is there where I thought there could be an excellent example of 
implementation of blockchain. Because it is about a processing model, 
state-machine, decisions, how good would it be for a performer to be 
able to prove: a decision taken on information or having taken a 
step, or other cicrumstances, by implementing the blockchain mechanism?


That would just be a classical use case for which blockchain was 
invented.



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Re: Blockchain

[Thomas Beale]

I agree, that's an interesting idea. I have not put any thought into it, 
but it's worth investigating. But we need to be clear on what problem is 
being solved here. Is it improvements in medico-legal standard of proof, 
or something else? What is the economic driver, and why are the current 
mechanisms (signing and versioning) not good enough?


- thomas


On 13/11/2017 14:02, Bert Verhees wrote:
Thomas, one  more remark, I remember the task-planning-specification 
where you have been working on, and on which you planning to give a 
presentation in London soon.


It is there where I thought there could be an excellent example of 
implementation of blockchain. Because it is about a processing model, 
state-machine, decisions, how good would it be for a performer to be 
able to prove: a decision taken on information or having taken a step, 
or other cicrumstances, by implementing the blockchain mechanism?


That would just be a classical use case for which blockchain was 
invented.



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Re: Blockchain

[Bert Verhees]

Thanks William, but that is just the association I want to avoid. 
OpenBazaar is about Bitcoin, which I find a not so welcome 
implementation of blockchain, although there are situations where it can 
help people for the good.
OpenBazaar seems to be inspired by a hackathon project called 
DarkMarket, and the association with illegal trade is too obvious, and 
not what I want to associate this discussion with.


However, there maybe elements in that which are usable in this 
discussion-context, but there are many documents on the Internet which 
describe research-results for blockchain in health-ICT and filtered out 
unwanted associations.


Bert


On 13-11-17 15:02, William Archibald wrote:


Bert, in particular, might find the collection of technologies around 
OpenBazaar[1][2] interesting.


It relies on DHT for it's P2P marketplace framework and 
implementation, Ricardian contracts[3] for agreements, 2-of-3 
multi-sig for escrow, BTC for remittance and IPFS for distributed file 
storage.



[1] https://www.openbazaar.org/
[2] https://en.wikipedia.org/wiki/OpenBazaar
[3] https://en.wikipedia.org/wiki/Ricardian_contract



On Mon, Nov 13, 2017 at 7:47 AM, Bert Verhees > wrote:


I understand, I take that as an authoritative answer to my
question why it hasn't been discussed in OpenEhr context.
The answer is also supported by Grahame. So what can I say ;-)

Thank you both for that.

I think that both of you will discuss within two years if and
maybe how to implement blockchain in OpenEhr and in FHIR.

In FHIR I think that discussion will come very sooner, because, it
is about messaging, and also, it describes technical layers.
In OpenEhr maybe in that discussion it will be rejected as
something because it will be regarded as not belonging to the
non-technical character of the Openehr-specification.

Best regards and thanks for the considerations
Bert



On 13-11-17 14:35, Thomas Beale wrote:


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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Re: Blockchain

[Bert Verhees]

On 13-11-17 15:00, Grahame Grieve wrote:


In FHIR I think that discussion will come very sooner, because, it
is about messaging, and also, it describes technical layers.


yes it did. I'm sceptical there for the same reasons. You can track 
the discussion if you are interested: 
https://chat.fhir.org/#narrow/stream/blockchain


Grahame



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thanks

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Re: Blockchain

[William Archibald]

Bert, in particular, might find the collection of technologies around
OpenBazaar[1][2] interesting.

It relies on DHT for it's P2P marketplace framework and implementation,
Ricardian contracts[3] for agreements, 2-of-3 multi-sig for escrow, BTC for
remittance and IPFS for distributed file storage.


[1] https://www.openbazaar.org/
[2] https://en.wikipedia.org/wiki/OpenBazaar
[3] https://en.wikipedia.org/wiki/Ricardian_contract



On Mon, Nov 13, 2017 at 7:47 AM, Bert Verhees  wrote:

> I understand, I take that as an authoritative answer to my question why it
> hasn't been discussed in OpenEhr context.
> The answer is also supported by Grahame. So what can I say ;-)
>
> Thank you both for that.
>
> I think that both of you will discuss within two years if and maybe how to
> implement blockchain in OpenEhr and in FHIR.
>
> In FHIR I think that discussion will come very sooner, because, it is
> about messaging, and also, it describes technical layers.
> In OpenEhr maybe in that discussion it will be rejected as something
> because it will be regarded as not belonging to the non-technical character
> of the Openehr-specification.
>
> Best regards and thanks for the considerations
> Bert
>
>
>
> On 13-11-17 14:35, Thomas Beale wrote:
>
>>
>> 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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>> openEHR-technical@lists.openehr.org
>> http://lists.openehr.org/mailman/listinfo/openehr-technical_
>> lists.openehr.org
>>
>
>
>
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Re: Blockchain

[Bert Verhees]

Thomas, one  more remark, I remember the task-planning-specification 
where you have been working on, and on which you planning to give a 
presentation in London soon.


It is there where I thought there could be an excellent example of 
implementation of blockchain. Because it is about a processing model, 
state-machine, decisions, how good would it be for a performer to be 
able to prove: a decision taken on information or having taken a step, 
or other cicrumstances, by implementing the blockchain mechanism?


That would just be a classical use case for which blockchain was invented.

Bert


On 13-11-17 14:35, Thomas Beale wrote:


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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Re: Blockchain

[Grahame Grieve]

>
> In FHIR I think that discussion will come very sooner, because, it is
> about messaging, and also, it describes technical layers.
>

yes it did. I'm sceptical there for the same reasons. You can track the
discussion if you are interested:
https://chat.fhir.org/#narrow/stream/blockchain

Grahame
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Re: Blockchain

[Karsten Hilbert]

On Mon, Nov 13, 2017 at 01:35:01PM +, Thomas Beale wrote:

> 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.

It never got any traction so we discontinued that project.

Karsten
-- 
GPG key ID E4071346 @ eu.pool.sks-keyservers.net
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

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Re: Blockchain

[Bert Verhees]

I understand, I take that as an authoritative answer to my question why 
it hasn't been discussed in OpenEhr context.

The answer is also supported by Grahame. So what can I say ;-)

Thank you both for that.

I think that both of you will discuss within two years if and maybe how 
to implement blockchain in OpenEhr and in FHIR.


In FHIR I think that discussion will come very sooner, because, it is 
about messaging, and also, it describes technical layers.
In OpenEhr maybe in that discussion it will be rejected as something 
because it will be regarded as not belonging to the non-technical 
character of the Openehr-specification.


Best regards and thanks for the considerations
Bert


On 13-11-17 14:35, Thomas Beale wrote:


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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Re: Blockchain

[Thomas Beale]

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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Re: Blockchain

[Bert Verhees]

On 13-11-17 14:02, Thomas Beale wrote:


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).




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.


Bert

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Re: Blockchain

[Bert Verhees]

On 13-11-17 13:55, GF wrote:

see below.

Gerard Freriks
+31 620347088
gf...@luna.nl 

On 13 Nov 2017, at 13:17, Bert Verhees > wrote:


Not very far from now (looking into the future, Scotty and Captain 
Kirk), health information will be a worldwide web.

Mayor players are diving into this trillion dollar business.

Health information will need to be accessible, and blockchain can be 
used to guard all interaction between systems.

You can find dozens of documents which handle about this.


Blockchain is a service that supplies functionality such as: 
non-repudiation, trust between parties in the public domain.

These functionalities can be achieved using existing technology.


Blockchain is existing technology. The first work on a cryptographically 
secured chain of blocks was described in 1991 by Stuart Haber and W. 
Scott Stornetta. In 1992, Bayer, Haber and Stornetta incorporated Merkle 
trees to the blockchain as an efficiency improvement to be able to 
collect several documents into one block. So 25 years old, which is 
quite old in IT history


NICTIZ sees some application of Blockchains at the IT-Infrastructure 
level: authentication, authorisation, and Access control.


OpenEHR is not a specification at the IT-Infrastructure level.


There a re a lot more applications of blockchain in healthcare ICT, also 
described in the document I linked to, in very simple examples.
Most important are transparent and provable tracking order of events, 
independent from sending/receiving computers, tracking of messages, it 
will be impossible to send a secret message, for example.


It is very convenient for the all  stakeholders to be able to be sure 
messages are only send to what they approved too at a moment they 
approved too, containing what they approved too.


This will become very important in the future when exchanging medical 
data will explode in volume.
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Re: Blockchain

[Thomas Beale]

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

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Re: Blockchain

[GF]

see below.

Gerard Freriks
+31 620347088
gf...@luna.nl

> On 13 Nov 2017, at 13:17, Bert Verhees  wrote:
> 
> Not very far from now (looking into the future, Scotty and Captain Kirk), 
> health information will be a worldwide web.
> Mayor players are diving into this trillion dollar business.
> 
> Health information will need to be accessible, and blockchain can be used to 
> guard all interaction between systems.
> You can find dozens of documents which handle about this.

Blockchain is a service that supplies functionality such as: non-repudiation, 
trust between parties in the public domain.
These functionalities can be achieved using existing technology.
In addition health is not something that takes place in the public domain.
There are not many things in healthcare that need anonymous transaction 
services that banks, notary public, provide.
Healthcare is highly personal.
> 
> In the Netherlands Nictiz is busy with it.
> 
> For example read this (sorry, only Dutch)
> https://www.nictiz.nl/SiteCollectionDocuments/Whitepapers/Blockchain_in_de_zorg.pdf
>  
> 

NICTIZ sees some application of Blockchains at the IT-Infrastructure level: 
authentication, authorisation, and Access control.

OpenEHR is not a specification at the IT-Infrastructure level.


> 
> Summarizing:
> - Blockchain is needed when interacting parties do not trust or know each 
> other
> - A trusted third party cannot be found or is not desirable
> - Validity en transparency of transactions is important
> - Stored or interchanged data are very important

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Re: Blockchain

[Bert Verhees]

I heard too about the enormous energy used by miners, and I heard also 
some solutions for health-ICT.


Because the miners in Health-ICT are nor working as fast as they can 
with dollar-signs in their eyes to create money, but they only create 
keys to facilitate the needed processes. So, maybe the idle running 
servers an create blocks, and they can use alternative methods which 
have other quality-features then the bitcoin, because they have another 
purpose. I don't know if it is feasible, but there are many publications 
about this subject.


About the data-state. In OpenEhr there is a state-machine, which has, at 
this moment no defined secure mechanism to ensure that the states truly 
reflect reality.

Maybe OpenEhr is not the place to define that, that is my original question.
But if OpenEhr wants to secure the states of the statemachine, 
blockchain can help.
For example, there is the often used medication-delivery-example. It has 
been subscribed, delivered, and the patient has taken it or stopped it, etc.
A chain of these connected events can be ensured truly happened if they 
are connected with blockchain. Their place in the chain of events is 
secured, and not changeable.


Bert

On 13-11-17 13:32, 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


Grahame


On Mon, Nov 13, 2017 at 11:24 PM, Bert Verhees > wrote:


On 13-11-17 13:06, GF wrote:

What problem is BlockChain solving, that deployed technologies
can not solve?


Read the document I linked to in my previous message, you can read
dutch.


Gerard Freriks
+31 620347088 
gf...@luna.nl 

On 13 Nov 2017, at 12:46, Bert Verhees
mailto:bert.verh...@rosa.nl>> wrote:

How are the plans about blockchain for OpenEhr? Is there
any plan to incorporate it in the standard, or is it
regarded as a technical implementers business?

Bert


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Re: Blockchain

[Bert Verhees]

On 13-11-17 13:23, Diego Boscá wrote:

I think the first point is key:
I don't really see an scenario where your health data would be sent to 
an untrusted source. But maybe in a future where we can envision an 
"ebay-like" service of distributed medical services or something like that


Depends on how you define trusted.
First of course there are the rights from the other to send/receive 
information, second is the transparency, a patient must be able to know 
who has received his data and which data. Blockchain can help in legal 
proceedings afterwards to proof why and when and how someone or some 
instance received information.


I think this will be very important in the near future when there will 
be more and more data-exchange. Not all countries have their healthcare 
governed in a single organization, but have many healthcare 
organizations, which can work together on curing a single patient.


Someone I know has now a medical problem with one of her legs. She is 
receiving healthcare from five parties, just to work on that problem: a 
specialist, the GP, a physiotherapist, a special shoemaker and the 
employer which needs to arrange special working place. That is the 
reality today, this will become more and more soon.


Bert




2017-11-13 13:17 GMT+01:00 Bert Verhees >:


Not very far from now (looking into the future, Scotty and Captain
Kirk), health information will be a worldwide web.
Mayor players are diving into this trillion dollar business.

Health information will need to be accessible, and blockchain can
be used to guard all interaction between systems.
You can find dozens of documents which handle about this.

In the Netherlands Nictiz is busy with it.

For example read this (sorry, only Dutch)

https://www.nictiz.nl/SiteCollectionDocuments/Whitepapers/Blockchain_in_de_zorg.pdf



Summarizing:
- Blockchain is needed when interacting parties do not trust or
know each other
- A trusted third party cannot be found or is not desirable
- Validity en transparency of transactions is important
- Stored or interchanged data are very important



On 13-11-17 13:02, Anastasiou A. wrote:

Perhaps an optional Blockchain capability could be added in
the service model, at points where an
"internal" system had to interface with one or more "external"
systems.

For example, you could provide access to a specific dataset
and blockchain calls that
modify its state.

This would then also require the extension of the service
model for verifying certain actions
against the blockchain.

Within the RM, there is the Feeder System Audit

(http://www.openehr.org/releases/RM/latest/docs/common/common.html#_feeder_system_audit

)

It's a new concept, still needs use cases about it I think.

All the best
Athanasios Anastasiou







-Original Message-
From: openEHR-technical
[mailto:openehr-technical-boun...@lists.openehr.org
] On
Behalf Of Bert Verhees
Sent: 13 November 2017 11:47
To: For openEHR technical discussions
Subject: Blockchain

How are the plans about blockchain for OpenEhr? Is there any
plan to incorporate it in the standard, or is it regarded as a
technical implementers business?

Bert


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Re: Blockchain

[Grahame Grieve]

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

Grahame


On Mon, Nov 13, 2017 at 11:24 PM, Bert Verhees  wrote:

> On 13-11-17 13:06, GF wrote:
>
>> What problem is BlockChain solving, that deployed technologies can not
>> solve?
>>
>
> Read the document I linked to in my previous message, you can read dutch.
>
>
>> Gerard Freriks
>> +31 620347088
>> gf...@luna.nl
>>
>> On 13 Nov 2017, at 12:46, Bert Verhees  wrote:
>>>
>>> How are the plans about blockchain for OpenEhr? Is there any plan to
>>> incorporate it in the standard, or is it regarded as a technical
>>> implementers business?
>>>
>>> Bert
>>>
>>>
>>> ___
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>>
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>> lists.openehr.org
>>
>
>
>
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Re: Blockchain

[Bert Verhees]

On 13-11-17 13:24, Anastasiou A. wrote:

I agree, I was referring to more use cases with the outlook of incorporating 
blockchain into the existing
openEHR model. Not blockchain itself.

(The bit about interacting parties is the "maybe add it in the service model" 
(?))


Maybe, I am not the specialist. I was wondering if or why it is (not) 
discussed in the OpenEhr circles (as far as I can see them)


Best regards
Bert

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Re: Blockchain

[Bert Verhees]

On 13-11-17 13:06, GF wrote:

What problem is BlockChain solving, that deployed technologies can not solve?


Read the document I linked to in my previous message, you can read dutch.


Gerard Freriks
+31 620347088
gf...@luna.nl


On 13 Nov 2017, at 12:46, Bert Verhees  wrote:

How are the plans about blockchain for OpenEhr? Is there any plan to 
incorporate it in the standard, or is it regarded as a technical implementers 
business?

Bert


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RE: Blockchain

[Anastasiou A .]

I agree, I was referring to more use cases with the outlook of incorporating 
blockchain into the existing 
openEHR model. Not blockchain itself.

(The bit about interacting parties is the "maybe add it in the service model" 
(?))





-Original Message-
From: Bert Verhees [mailto:bert.verh...@rosa.nl] 
Sent: 13 November 2017 12:17
To: Anastasiou A.; For openEHR technical discussions
Subject: Re: Blockchain

Not very far from now (looking into the future, Scotty and Captain Kirk), 
health information will be a worldwide web.
Mayor players are diving into this trillion dollar business.

Health information will need to be accessible, and blockchain can be used to 
guard all interaction between systems.
You can find dozens of documents which handle about this.

In the Netherlands Nictiz is busy with it.

For example read this (sorry, only Dutch) 
https://www.nictiz.nl/SiteCollectionDocuments/Whitepapers/Blockchain_in_de_zorg.pdf

Summarizing:
- Blockchain is needed when interacting parties do not trust or know each other
- A trusted third party cannot be found or is not desirable
- Validity en transparency of transactions is important
- Stored or interchanged data are very important


On 13-11-17 13:02, Anastasiou A. wrote:
> Perhaps an optional Blockchain capability could be added in the service 
> model, at points where an
> "internal" system had to interface with one or more "external" systems.
>
> For example, you could provide access to a specific dataset and blockchain 
> calls that
> modify its state.
>
> This would then also require the extension of the service model for verifying 
> certain actions
> against the blockchain.
>
> Within the RM, there is the Feeder System Audit 
> (http://www.openehr.org/releases/RM/latest/docs/common/common.html#_feeder_system_audit)
>
> It's a new concept, still needs use cases about it I think.
>
> All the best
> Athanasios Anastasiou
>
>
>
>
>
>
>
> -Original Message-
> From: openEHR-technical [mailto:openehr-technical-boun...@lists.openehr.org] 
> On Behalf Of Bert Verhees
> Sent: 13 November 2017 11:47
> To: For openEHR technical discussions
> Subject: Blockchain
>
> How are the plans about blockchain for OpenEhr? Is there any plan to 
> incorporate it in the standard, or is it regarded as a technical implementers 
> business?
>
> Bert
>
>
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Re: Blockchain

[Diego Boscá]

I think the first point is key:
I don't really see an scenario where your health data would be sent to an
untrusted source. But maybe in a future where we can envision an
"ebay-like" service of distributed medical services or something like that

2017-11-13 13:17 GMT+01:00 Bert Verhees :

> Not very far from now (looking into the future, Scotty and Captain Kirk),
> health information will be a worldwide web.
> Mayor players are diving into this trillion dollar business.
>
> Health information will need to be accessible, and blockchain can be used
> to guard all interaction between systems.
> You can find dozens of documents which handle about this.
>
> In the Netherlands Nictiz is busy with it.
>
> For example read this (sorry, only Dutch)
> https://www.nictiz.nl/SiteCollectionDocuments/Whitepapers/
> Blockchain_in_de_zorg.pdf
>
> Summarizing:
> - Blockchain is needed when interacting parties do not trust or know each
> other
> - A trusted third party cannot be found or is not desirable
> - Validity en transparency of transactions is important
> - Stored or interchanged data are very important
>
>
>
> On 13-11-17 13:02, Anastasiou A. wrote:
>
>> Perhaps an optional Blockchain capability could be added in the service
>> model, at points where an
>> "internal" system had to interface with one or more "external" systems.
>>
>> For example, you could provide access to a specific dataset and
>> blockchain calls that
>> modify its state.
>>
>> This would then also require the extension of the service model for
>> verifying certain actions
>> against the blockchain.
>>
>> Within the RM, there is the Feeder System Audit (
>> http://www.openehr.org/releases/RM/latest/docs/common/
>> common.html#_feeder_system_audit)
>>
>> It's a new concept, still needs use cases about it I think.
>>
>> All the best
>> Athanasios Anastasiou
>>
>>
>>
>>
>>
>>
>>
>> -Original Message-
>> From: openEHR-technical [mailto:openehr-technical-boun
>> c...@lists.openehr.org] On Behalf Of Bert Verhees
>> Sent: 13 November 2017 11:47
>> To: For openEHR technical discussions
>> Subject: Blockchain
>>
>> How are the plans about blockchain for OpenEhr? Is there any plan to
>> incorporate it in the standard, or is it regarded as a technical
>> implementers business?
>>
>> Bert
>>
>>
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>> lists.openehr.org
>>
>
>
>
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Re: Blockchain

[Bert Verhees]

Not very far from now (looking into the future, Scotty and Captain 
Kirk), health information will be a worldwide web.

Mayor players are diving into this trillion dollar business.

Health information will need to be accessible, and blockchain can be 
used to guard all interaction between systems.

You can find dozens of documents which handle about this.

In the Netherlands Nictiz is busy with it.

For example read this (sorry, only Dutch)
https://www.nictiz.nl/SiteCollectionDocuments/Whitepapers/Blockchain_in_de_zorg.pdf

Summarizing:
- Blockchain is needed when interacting parties do not trust or know 
each other

- A trusted third party cannot be found or is not desirable
- Validity en transparency of transactions is important
- Stored or interchanged data are very important


On 13-11-17 13:02, Anastasiou A. wrote:

Perhaps an optional Blockchain capability could be added in the service model, 
at points where an
"internal" system had to interface with one or more "external" systems.

For example, you could provide access to a specific dataset and blockchain 
calls that
modify its state.

This would then also require the extension of the service model for verifying 
certain actions
against the blockchain.

Within the RM, there is the Feeder System Audit 
(http://www.openehr.org/releases/RM/latest/docs/common/common.html#_feeder_system_audit)

It's a new concept, still needs use cases about it I think.

All the best
Athanasios Anastasiou







-Original Message-
From: openEHR-technical [mailto:openehr-technical-boun...@lists.openehr.org] On 
Behalf Of Bert Verhees
Sent: 13 November 2017 11:47
To: For openEHR technical discussions
Subject: Blockchain

How are the plans about blockchain for OpenEhr? Is there any plan to 
incorporate it in the standard, or is it regarded as a technical implementers 
business?

Bert


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Re: Aw: Re: Aw: Blockchain

[Bert Verhees]

better an old joke then everybody sad ;-)

On 13-11-17 13:04, Birger Haarbrandt wrote:

;) Sorry, I could not resist
--
Diese Nachricht wurde von meinem Android Mobiltelefon mit 1&1 Mail 
gesendet.
Am 13.11.17, 12:59 PM, Bert Verhees @rosa.nl> schrieb:


On 13-11-17 12:52, Birger Haarbrandt wrote:

Hi Bert,

I think this highly depends on the color of the blockchain.


https://twitter.com/backfeed_cc/status/684338051263369216



Best,

Birger

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Mail gesendet.
Am 13.11.17, 12:46 PM, Bert Verhees http://bert.verhees>@rosa.nl> schrieb:

How are the plans about blockchain for OpenEhr? Is there any
plan to
incorporate it in the standard, or is it regarded as a technical
implementers business?

Bert


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Re: Blockchain

[GF]

What problem is BlockChain solving, that deployed technologies can not solve?

Gerard Freriks
+31 620347088
gf...@luna.nl

> On 13 Nov 2017, at 12:46, Bert Verhees  wrote:
> 
> How are the plans about blockchain for OpenEhr? Is there any plan to 
> incorporate it in the standard, or is it regarded as a technical implementers 
> business?
> 
> Bert
> 
> 
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Aw: Re: Aw: Blockchain

[Birger Haarbrandt]

;) Sorry, I could not resist
-- 
Diese Nachricht wurde von meinem Android Mobiltelefon mit 1&1 Mail gesendet.Am 13.11.17, 12:59 PM, Bert Verhees  schrieb:

  
On 13-11-17 12:52, Birger Haarbrandt
  wrote:


  
  
  Hi Bert,

I think this highly depends on the color of the blockchain.
  


https://twitter.com/backfeed_cc/status/684338051263369216


  

Best,

Birger

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Diese Nachricht wurde von meinem Android Mobiltelefon mit
1&1 Mail gesendet.
  Am 13.11.17, 12:46 PM, Bert Verhees 
schrieb:

  How are the plans about blockchain for OpenEhr? Is there any
  plan to 
  incorporate it in the standard, or is it regarded as a
  technical 
  implementers business?
  
  Bert
  
  
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RE: Blockchain

[Anastasiou A .]

Perhaps an optional Blockchain capability could be added in the service model, 
at points where an 
"internal" system had to interface with one or more "external" systems.

For example, you could provide access to a specific dataset and blockchain 
calls that 
modify its state.

This would then also require the extension of the service model for verifying 
certain actions 
against the blockchain.

Within the RM, there is the Feeder System Audit 
(http://www.openehr.org/releases/RM/latest/docs/common/common.html#_feeder_system_audit)
 

It's a new concept, still needs use cases about it I think.

All the best
Athanasios Anastasiou







-Original Message-
From: openEHR-technical [mailto:openehr-technical-boun...@lists.openehr.org] On 
Behalf Of Bert Verhees
Sent: 13 November 2017 11:47
To: For openEHR technical discussions
Subject: Blockchain

How are the plans about blockchain for OpenEhr? Is there any plan to 
incorporate it in the standard, or is it regarded as a technical implementers 
business?

Bert


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Re: Aw: Blockchain

[Bert Verhees]

On 13-11-17 12:52, Birger Haarbrandt wrote:

Hi Bert,

I think this highly depends on the color of the blockchain.


https://twitter.com/backfeed_cc/status/684338051263369216



Best,

Birger

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Diese Nachricht wurde von meinem Android Mobiltelefon mit 1&1 Mail 
gesendet.
Am 13.11.17, 12:46 PM, Bert Verhees @rosa.nl> schrieb:


How are the plans about blockchain for OpenEhr? Is there any plan to
incorporate it in the standard, or is it regarded as a technical
implementers business?

Bert


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Re: Blockchain

[Bert Verhees]

For example to guarantee a position of a composition in a chain of 
events, or use it in audits for the same purpose.


There is a lot of noise about blockchain in health-ict. So, I wonder if 
there are plans to incorporate it in the standard. But maybe it is 
regarded as something technical OpenEhr does not want to get involved with.


Bert



On 13-11-17 12:49, Diego Boscá wrote:

Hi Bert,

Where do you want to apply it?

2017-11-13 12:46 GMT+01:00 Bert Verhees >:


How are the plans about blockchain for OpenEhr? Is there any plan
to incorporate it in the standard, or is it regarded as a
technical implementers business?

Bert


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Aw: Blockchain

[Birger Haarbrandt]

Hi Bert,

I think this highly depends on the color of the blockchain.

Best,

Birger

-- 
Diese Nachricht wurde von meinem Android Mobiltelefon mit 1&1 Mail gesendet.Am 13.11.17, 12:46 PM, Bert Verhees  schrieb:
How are the plans about blockchain for OpenEhr? Is there any plan to 
incorporate it in the standard, or is it regarded as a technical 
implementers business?

Bert


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Re: Blockchain

[Diego Boscá]

Hi Bert,

Where do you want to apply it?

2017-11-13 12:46 GMT+01:00 Bert Verhees :

> How are the plans about blockchain for OpenEhr? Is there any plan to
> incorporate it in the standard, or is it regarded as a technical
> implementers business?
>
> Bert
>
>
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<+34%20627%2001%2050%2023>
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Re: Blockchain

[Grahame Grieve]

what would it do?

Grahame


On Mon, Nov 13, 2017 at 10:46 PM, Bert Verhees  wrote:

> How are the plans about blockchain for OpenEhr? Is there any plan to
> incorporate it in the standard, or is it regarded as a technical
> implementers business?
>
> Bert
>
>
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Blockchain

[Bert Verhees]

How are the plans about blockchain for OpenEhr? Is there any plan to 
incorporate it in the standard, or is it regarded as a technical 
implementers business?


Bert


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Re: Stackoverflow tag: openehr

[Bert Verhees]

Hi Gavin, I have seen that.
At least there is activity now around this tag. I hope others (unknown 
to this inner-circle) will pick it up.
I am subscribed to the tag now, so I will be notified once a day when 
there is activity

We have done our best and cannot do more for now.

I hope OpenEhr will break out of the inner-circles in which it seems to 
be now (to my feeling)


Best regards and thanks
Bert Verhees


On 13-11-17 12:31, gjb wrote:

On 11/11/2017 18:28, Bert Verhees wrote:

Well done, Gavin,

I hope there will be the needed activity. It may, for some people, 
being more ad hoc possible to ask questions on Stackoverflow, instead 
of on one of the mailing lists. We already had once a discussion 
about OpenEhr on StackOverflow, but it was not tagged right.



Hi Bert

I've tagged quite a few existing questions now:

  https://stackoverflow.com/questions/tagged/openehr

hope that helps

\Gavin


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Re: Stackoverflow tag: openehr

[gjb]

On 11/11/2017 18:28, Bert Verhees wrote:

Well done, Gavin,

I hope there will be the needed activity. It may, for some people, being 
more ad hoc possible to ask questions on Stackoverflow, instead of on 
one of the mailing lists. We already had once a discussion about OpenEhr 
on StackOverflow, but it was not tagged right.



Hi Bert

I've tagged quite a few existing questions now:

  https://stackoverflow.com/questions/tagged/openehr

hope that helps

\Gavin


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