AMCHART : Patient driven EMR on a public/private Blockchain with AI for Analytics and Incentive driven model for better Outcomes

April 24, 2018

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AMCHART is a patient driven EMR on a public/private blockchain with AI for analytics and incentive driven model for better outcomes. The incentive driven model is based on maintenance of health records, wellness program participation, population health, and data sharing with certified partners for analytics and proactive healthcare management. The consensus security is based on Intel SGX chips and running the consensus directly on hardware not only provides extra security but also accelerate transaction times and stabilizes our ability to decentralize the medical record appropriately. AMCHART will be utilizing Ethereum based Smart Contracts and a Hyperledger Sawtooth framework to create a secure pathway to access patient data for both patients and providers.



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Electronic Medical Records


Electronic health records have been around for several decades and in that that time, EMR companies have not integrated themselves to share data, but siloed themselves to protect their own products, increase reliance on their legacy systems, and have prohibitive costs preventing mid to large sized groups from leaving them for better alternatives.


Another consideration is that consumers find multiple iterations of EMRs from “free” to cloud based and even older on-site managed systems.  These centralized platforms have raised issues with security, difficulty with managing data breaches, and recent media reports describing data loss.


Since the initiation of the Health Information Technology for Economic and Clinical Health (HITECH) Act, as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, to promote the adoption and meaningful use of health information technology.  This led to a mad scramble for providers to incorporate EHRs into their practice and to take their own traditional pathways for records reconciliation out of the equation.  Some of the benefits touted by EHR companies include:

  • Easier access to patient information

  • Improved billing and coding of visits

  • Reduction in transcription costs

  • Improved pharmacy based issues allowing quicker connection for medication fulfillment

  • Improved preventative care plans

  • Easier disease management, especially for chronic disease patients

  • Evidenced-based practice


These are all fantastic promises and allows providers improved patient care possibilities, but it also does not consider the learning curve for a staff, or the ability to incorporate modern technologies into old practice habits, which can be difficult and decrease provider productivity.


As part of moving towards a consensus with the integration of new laws, providers scrambled to find EMRs which would be compatible with their practice and ended up with expensive, slow, and inefficient records which hindered their ability to practice and maintain the patient volumes with which they were accustomed. Also, a big selling point by many EMR companies was to utilize interfaces and allow one EMR to communicate with another to improve information sharing, improved access to medical management, and to create an ecosystem of health to affect patients and lower costs and malpractice.


But this is not what is seen in the current marketplace.  Even though some EHR/EMR systems can be similar in the information obtained from patient and through physicians, the ability to share that information can be constrained because of company policies and protection of their own intellectual property.  This, in turn, leads to difficulty with keeping providers up to date, increased issues with compliance (maintaining safety of patient’s information) when documents are sent (by mail or faxing), and increases workloads on medical practices instead of doing what they do best, which is to care for patients.


The other issue noted on these systems is the lack of access for the patient.  When a patient attempts to access their records on legacy systems, it is difficult to gain those records in a timely manner.  Often, patients cannot obtain a digital record, but must pay for their records to be printed and picked up or mailed later.  If a patient has an immediate appointment with another practitioner, they may find getting to the right person in a medical records department to fax a record or to print it may take 2-3 days.



Patient Access to Medical Records


The AMCHART development team is looking to make the access to the medical record seamless for both patients and providers.  It may seem complicated through words, but AMCHART aims to make it as simple as logging into your favorite website.


Patient will login through an identity authentication mechanism (blockchain based) and Web interface will log in the user into the permissioned Blockchain (Hyperledger) and Once in, the basic profile will be seen including demographics, wellness data, etc.


After login, patient will have access to tokens available to perform any user transaction, see what transactions have been made, what updates have been performed to the medical record, and all transactions associated with it.


There is concern for a patient’s private key and how it can be maintained. We will provide several methods of storage including secure storage for AMCHART participants with two-factor authentication process and back-ups to their own systems available through support.  We are also exploring new blockchain technology that will allow their private key to be shifted into a short name or picture with ease of entry into the medical record for easy recall of their private key.



AMCHART Project Roadmap


All the timelines are tentative in nature and require the ability to forge the blockchain/API/apps required for initial phases along with testing for function in real-world environments.  AMCHART already has connections with medical practices and ancillary facilities to work in a test environment and help our team to create the proper procedures for the new token system.  Access to the system and how the token will gain its usage will be determined by the guidance from providers and patients.


Phase I – this will be the initial MVP (minimal viable product) with the security structures enabled.  Both providers and patients will be able to have access and patients can create medical records, create permissioned access, and build upon the medical records.  This will occur by mid to late January 2018.  We will also begin the process of developing our mobile application and testing wearables for real time patient monitoring of heart rate, blood pressure, O2 sat, weight, blood sugar, and heart health during this time for initiating wellness programs


Phase II – during this period, which is happening throughout Phase I, we will be utilizing all datasets for statistical analysis and working with research groups, payors, providers through machine learning and AI processes.  We will be working to answer specific questions through AI and to assist these groups with proper utilization of data.  Wellness programs will be tested through partnerships with several physician groups and wellness programs in California, Texas, and Missouri.  We expect completion of this phase by end of Summer 2018.


Phase III – We will have full activation of wellness programs with app usage and real-time monitoring and access of data through the EHR.  We will have full AI capabilities to assist all organizations to answer the questions they want to address about the healthcare cycle (disease processes, medication usage, wellness management, proactive diagnosis, etc.).  Also, we will begin integration of billing components and payment processing from payors to providers through blockchain intermediaries.


The AMCHART development team will work to forge partnerships to utilize current blockchain technology from other healthcare companies along with layering our tech stack on top of it.  rough current partners and plug and play modules available that can be modified with security


Patients will need to trust that the system is accurate about the records moving between hospitals and within the network. They will also know that the information has undergone validation which provides further confidence in the system.


Security is a crucial area in healthcare currently, especially as data sharing becomes more popular.


Efforts toward interoperability between blockchain and middleware, along with population health and accountable care, means that the data is going to be exchanged across systems that has varying degrees and various levels of privacy and security rules and regulations.


Cross-chain along with HIE security is a crucial area, especially as data sharing becomes more popular.  Customers want information readily available, but it is imperative to ensure that the data is only used, or disclosed, as is appropriate and permitted by regulations. Patient information would need to remain secure through any cross-chain transfer process, so covered entities should consider the necessary safeguards that may need to be implemented as well.

Data encryption implementation is process. AMCHART will be using methods such as NIST cryptographic standards. NIST addresses the importance of encrypting sensitive data by transforming it into an incomprehensible format until a recipient with a private key can unlock the information. AMCHART will adopt strong and effective cryptographic standards and guidelines that are broadly accepted and trusted by our stakeholders.


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