Srinivasan Sundararajan
Patient Care Redefined
The fight against the novel coronavirus has witnessed transformational changes in the way patient care is defined and managed. Proliferation of telemedicine has enabled consultations across geographies. In the current scenario, access to patients’ medical records has also assumed more importance.
The journey towards a solution also taught us that research on patient data is equally important. More the sample data about the infected patients, the better the vaccine/remedy. However, the growing concern about the privacy of patient data cannot be ignored. Moreover, patients who provide their data for medical research should also benefit from a monetary perspective, for their contributions.
The above facts basically point to the need for being able to share vital healthcare data efficiently so that patient care is improved, and more lives are saved.
The healthcare industry needs a data-sharing framework, which shares patient data but also provides much-needed controls on data ownership for various stakeholders, including the patients.
Types of Healthcare Data
- PHR (Personal Health Record): An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.
- EMR (Electronic Medical Record): Health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.
- EHR (Electronic Health Record): Health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization.
In the context of large multi-specialty hospitals, EMR could also be specific to one specialist department and EHR could be the combination of information from various specialist departments in a single unified record.
Together these 3 forms of healthcare data provide a comprehensive view of a patient (patient 360), thus resulting in quicker diagnoses and personalized quality care.
Current Challenges in Sharing Healthcare Data
- Lack of unique identity for patients prevents a single version of truth. Though there are government-issued IDs like SSN, their usage is not consistent across systems.
- High cost and error-prone integration options with provider controlled EMR/EHR systems. While there is standardization with respect to healthcare interoperability API specifications, the effort needed for integration is high.
- Conflict of interest in ensuring patient privacy and data integrity, while allowing data sharing. Digital ethics dictate that patient consent management take precedence while sharing their data.
- Monetary benefits of medical research on patient data are not passed on to patients. As mentioned earlier, in today’s context analyzing existing patient information is critical to finding a cure for diseases, but there are no incentives for these patients.
- Data stewardship, consent management, compliance needs like HIPAA, GDPR. Let’s assume a hospital specializing in heart-related issues shares a patient record with a hospital that specializes in eye care. How do we decide which portions of the patient information is owned by which hospital and how the governance is managed?
- Lack of real-time information attributing to data quality issues and causing incorrect diagnoses.
The above list is not comprehensive but points to some of the issues that are plaguing the current healthcare data-sharing initiatives.
Blockchain for Healthcare Data Sharing
Some of the basic attributes of blockchain are mentioned below:
- Blockchain is a distributed database, whereby each node of the database can be owned by a different stakeholder (say hospital departments) and yet all updates to the database eventually converge resulting in a distributed single version of truth.
- Blockchain databases utilize a cryptography-based transaction processing mechanism, such that each object stored inside the database (say a patient record) can be distinctly owned by a public/private key pair and the ownership rights carry throughout the life cycle of the object (say from patient admission to discharge).
- Blockchain transactions are carried out using smart contracts which basically attach the business rules to the underlying data, ensuring that the data is always compliant with the underlying business rules, making it even more reliable than the data available in traditional database systems.
These underlying properties of Blockchain make it a viable technology platform for healthcare data sharing, as well as to ensure data stewardship and patient privacy rights.
GAVS Rhodium Framework for Healthcare Data Sharing
GAVS has developed a framework – ‘Rhodium’, for healthcare data sharing.
This framework combines the best features of multi-modal databases (relational, nosql, graph) along with the viability of data sharing facilitated by Blockchain, to come up with a unified framework for healthcare data sharing.
The following are the high-level components (in a healthcare context) of the Rhodium framework. As you can see, each of the individual components of Rhodium play a role in healthcare information exchange at various levels.
GAVS’ Rhodium Framework for Healthcare
GAVS has also defined a maturity model for healthcare organizations for utilizing the framework towards healthcare data sharing. This model defines 4 stages of healthcare data sharing:
- Within a Hospital
- Across Hospitals
- Between Hospitals & Patients
- Between Hospitals, Patients & Other Agencies
The below progression diagram illustrates how the framework can be extended for various stages of the life cycle, and typical use cases that are realized in each phase. Detailed explanations of various components of the Rhodium framework, and how it realizes use cases mentioned in the different stages will be covered in subsequent articles in this space.
Rhodium Patient Date Sharing Journey
Benefits of the GAVS Rhodium Framework for Healthcare Data Sharing
The following are the general foreseeable benefits of using the Rhodium framework for healthcare data sharing.
Healthcare Industry Trends with Respect to Data Sharing
The following are some of the trends we are seeing in Healthcare Data Sharing:
- Interoperability will drive privacy and security improvements
- New privacy regulations will continue to come up, in addition to HIPAA
- The ethical and legal use of AI will empower healthcare data security and privacy
- The rest of 2020 and 2021 will be defined by the duality of data security and data integration, and providers’ ability to execute on these priorities. That, in turn, will, in many ways, determine their effectiveness
- In addition to industry regulations like HIPAA, national data privacy standards including Europe’s GDPR, California’s Consumer Privacy Act, and New York’s SHIELD Act will further increase the impetus for providers to prioritize privacy as a critical component of quality patient care
The below documentation from the HIMSS site talks about maturity levels with respect to healthcare interoperability, which is addressed by the Rhodium framework.
Source: https://www.himss.org/what-interoperability
This framework is in its early stages of experimentation and is a prototype of how a Blockchain + Multi-Modal Database powered solution could be utilized for sharing healthcare data, that would be hugely beneficial to patients as well as healthcare providers.
About the Author –
Srini is the Technology Advisor for GAVS. He is currently focused on Data Management Solutions for new-age enterprises using the combination of Multi-Modal databases, Blockchain, and Data Mining. The solutions aim at data sharing within enterprises as well as with external stakeholders.