Iris EHR : Your Decentralized Electronic Healthcare Record

February 23, 2018

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Blockchain-based applications and currencies have made a substantial impact on the field of financial technologies. However, blockchain technology applies to many other sectors, and is particularly suited to the management of Electronic Health Records (EHRs), a field where authentication, accountability, and the maintenance of an unchanging, secure log is extremely important.


The volumes of data being generated by modern medical technology are often scattered across medical practitioners, inaccessible to the patient, and stored using insecure and impermanent methods. On the contrary, in a blockchain based model patient care such as medical tests, interventions and outcomes can be decentralized across providers, giving patients access to their comprehensive record and preventing duplication and information loss.


Agents in the medical sphere such as researchers and governments, as well as insurance providers and pharmaceutical companies, are incentivized to participate by the reward of access to aggregate, anonymized medical data, which they can access by buying and trading Iris Tokens on a designated marketplace. The adoption of blockchain technology into the EHR sphere has the potential to revolutionize patient-centered care as well as provide big data to researchers working on important healthcare breakthroughs.


Iris EHR


The Iris blockchain network, a decentralized electronic healthcare record (Iris EHR) system is currently under development.


Using public key cryptography, a time-stamped, unalterable chain of records is created by users (“Miners”) who upload personal healthcare data and earn Iris Tokens. An Iris EHR Marketplace is created to enable interested third parties to purchase healthcare data from the database using Iris Tokens. Miners or supporters possessing tokens can further sell them to buyers on existing cryptocurrency exchanges.


Blockchain technology ensures sensitive medical data is decentralized, confidential, robust against deletion or alteration, yet able to be shared and accessed with ease and rapidity. In this paper, we introduce the Iris ecosystem, formalize key terms, agents and modes of operation, and present details of the underlying technology along with use cases.



Existing Electronic Healthcare Records


(EHRs) are a relic of a non-globalized age where information was fragmented, impermanent, and obfuscated from the patients who generate that information. Healthcare data today is localized to provider and/or insurance networks, which leads to the scattering and loss of this data as a patient moves between healthcare providers and payers, limiting the quality of their care. Hospitals and doctors spend inordinate amounts of time and money setting up involved information storage and 3 management systems, which are typically non-shareable between providers, inaccessible to patients, and vulnerable to data loss and alteration. This erodes patient trust and potentially makes them unwilling to seek treatment or disclose sensitive medical information. Perhaps most dangerously, doctors and patients are often unable to obtain the complete and chronological picture of the care they provide and receive, putting lives at risk.


On the other side of the healthcare spectrum, researchers working to combat diseases and public health crises need access to current, verified and consensually provided data from all sections of the population. Currently, the difficulty of sharing large amounts of data while maintaining confidentiality means that researchers are restricted to small amounts of data from sources such as volunteers, surveys and clinical studies.


A blockchain network will generate large, decentralized database of indexed and accurate medical data which will be invaluable to biomedical and public health researchers, and a means for patients to consensually provide their data for these purposes. The assurance of responsible and respectful sharing of data, backed by a secure and verified record, could usher in a revolution in the conduct of clinical trials and the development of new treatments. A blockchain-based EHR takes the work of maintaining medical records from the hands of hospitals and providers, who are in no way specialized for it, into the realm of a fault-tolerant, decentralized, distributed computing network.


Taking the distributed ledger aspect of bitcoin, and the smart contract aspect of currencies such as Ethereum, we can begin to construct an EHR distributed over a private, peer-to-peer network. Patient-provider relationships are recorded in the form of transactions, with each block encoding associated viewing and sharing permissions. This provides fast access to patient data in situations where such access may constitute a matter of life-and-death. In addition, it creates a permanent, time-stamped record of transactions, preventing record-related malpractice and providing a verifiable history of care. Patients can view their own records without obfuscation, as well as provide access and sharing permissions to different providers, keeping them engaged in their own care.



Security and Privacy


In May 2017, a cyber attack on the UK’s National Health Service (the NHS) brought hospital trusts to their knees, with some disruptions lasting weeks. While patient records are not known to be compromised yet, the scale and ease of the attack was a cautionary tale against the storage of centralized banks of sensitive medical data using the near-obsolete IT technology available to hospitals. The incident cast the importance of securing medical data and protecting the privacy of patients. A blockchain implementation enjoys several key advantages over standard EHRs in use today, in terms of security and privacy.


The decentralization of data into a chain of blocks over a peer-to peer network is an inherently fault-tolerant model, since there is no single target for a malicious attack. Medical records can continue to be stored locally in separate provider or in patient databases, while copies of validation logs and transactions are stored on each user in the network. This ensures that the raw medical data is decentralized in different databases, while similarly the validated transactions are distributed as they are in the blockchain.


The issue of privacy, another important concern for sensitive medical data, can be addressed by making the blockchain a structure where only pre-approved, known users (for example, agents such as providers, patients and insurance companies) are allowed read access to the distributed ledger. This would prevent both unauthorized access to patient data as well as rogue actors running analytics on the database and obtaining aggregate data. In addition, an encryption step can be added when the data is synced to the 5 blockchain, preventing accidental or malicious content access.


Lastly, security of another kind, namely an unalterable chronological record of care, is provided by the Iris EHR. In legacy EHR systems, anyone with access to the EHR can add, alter or delete medical data and records of interventions; this is not possible in a blockchain implementation, since transactions are append-only, validated with timestamps and immediately mirrored across multiple users.



Core features of the Iris EHR 


The Iris EHR is a crucial part of the ecosystem. It is a database built on two core principles; individualized healthcare which is tailored to a patient and is part of their comprehensive record, and preventative, long-term wellness and the maintenance of health instead of a reactionary model treating episodic illness. Other features will include the standardization and integration of existing provider health records across institutions and countries. With AI, machine learning and a critical mass of accumulated information, providers’ focus could shift away from treatment to prevention, using predictive models and an automated primary care service.





Patients will be able to upload health records, as well as self-generated data from wearables, implants, and health tracking apps via a user- friendly application. They will have access to a Personal Health Record, including all data generated by the patient, their provider, or their test results.


An Episodic Healthcare Management system will arrange vir- tual consultations (e-visits), coordinate pre- and post-follow up ques- tions, include inpatient functionality such as hospital visits, and sched- ule appointments. A Personal Healthcare Management system will monitor a patient’s health data. Fine-grained permissions controls will allow patients to tailor access to their data for different categories of people, for example for their family, provider, payer (perhaps an insur- ance company) and even for buyers in the Iris Marketplace.




Providers will be able to upload data they generate (with permission, if a patient is involved). While we have mentioned the reduction of data storage, backup and management overload due to blockchain technol- ogy, other features such as practice management, reduction of negli- gence, time savings for clinicians and simple recordkeeping integrity will be powerful tools.


Handling of outpatient care, remote virtual care (reducing unnecessary doctor visits), automated and remote pa- tient monitoring, as well as facilitated peer-to-peer interactions will be strong incentives for providers to use the Iris EHR. Care management as well as utilization management for physicians will be a welcome light- ening of their workload, as well as provide safety benefits by reducing overworked doctors. The creation of the Iris Marketplace where health- care vendors can bid on patients needing services wil also improve the quality of care.




Payers could greatly reduce overheads by implementing features of the Iris EHR, including immediate and automated claims validation and processing, as well as a simplified revenue cycle with paperless billing and payment plans. Proof of insurance would be automatic as well, and fraud prevention would become easier if diagnostic machines registered on the secure distributed ledger could append onto it the validated tests they perform, with bills sent directly to the payer. The ledger would provide drug traceability (a major concern for pharmaceu- ticals companies, who lose an estimated USD 12 billion annually due to the sale of counterfeit chemicals). Medication nonadherence costs drug companies an estimated USD 637 billion annually, and could be prevented, or at least detected, via the Iris EHR. Payers (such as gov- ernments or research institutions) could also incentivize members of the populace to perform designated activities (for example, exercise or preventative care) by offering Iris Tokens.


Apart from these features, public health bodies would be able to provide health documentation and validate them, aiding in drug traceability as well as in the running of vaccination programs.

The initial focus will be on data collection in the clinical context, fol- lowed by data collection from other, non-traditional sources such as at-home wearable health devices. The Iris EHR will become a database of healthcare data, which can be aggregated and anonymized to varying degrees, and sold to Buyers. 



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