In this section, three use cases of blockchain in Healthcare will be presented. For each use case, guide questions will be provided.
Use Case 1: Simple EHR Workflow
In a single health facility, all health transactions are uploaded to the blockchain. Using smart contracts, the designated personnel will be informed if a particular task is assigned to him. Example:
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(1)
Doctor X requests for an X-Ray on Patient Y from Radiologist Z.
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(2)
The request is stored in the blockchain
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(3)
Radiologist Z is informed that such a task is assigned to him.
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(4)
Radiologist Z performs an X-Ray on Patient Y
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(5)
Radiologist Z stores result of X-Ray in blockchain
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(6)
Doctor X is informed that the result is already available.
All the transactions are stored in the blockchain. Transactions are stored in the blockchain because there are many participants that are modifying the health/medical records of a patient.
Guide Questions:
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(1)
Who are the participants in the blockchain?
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(2)
What kind of blockchain design can be used?
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(3)
What are the potential issues in this design?
Suggested Answers:
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(1)
The participants of the blockchain are the different health providers in a facility. All participants should have a copy of the blockchain.
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(2)
A private/permissionless blockchain may be used since the health providers in the facility is a controlled population, and authentication credentials can be easily provided.
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(3)
The biggest issue with this design is that actual health data is stored in the blockchain. Another potential issue is scalability since all transactions done in the hospital will be recorded in the blockchain hence increasing its length.
Use Case 2: A Health Maintenance Organization (HMO) Claim Blockchain Workflow
In this workflow, there will be 5 identified transactions:
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(1)
Facility and HMO agrees to a contract of service
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(2)
Patient is enrolled in HMO
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(3)
Service is rendered by Facility to the Patient
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(4)
Facility makes a Claim from the HMO
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(5)
HMO pays claim.
Smart contracts can be assigned in the process. An example of smart contract use is to check whether there is an existing contract of service between the HMO and the Facility, and whether a patient is enrolled in an HMO, and whether service is provided to the patient, whenever a facility makes a claim from an HMO.
Guide Questions:
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(1)
Who are the participants in the blockchain?
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(2)
What kind of blockchain design can be used?
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(3)
What are the advantages of using blockchain in this workflow?
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(4)
What are the potential issues in this design?
Suggested Answers:
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(1)
The participants are the facilities, HMOs and the patients. Each may not need to have the contents of the whole blockchain (patients won’t need the transaction nodes that are attributed from other patients).
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(2)
Since patients are participants, a public blockchain may be used. But since patients won’t push data to the blockchain, it is possible that a permissionless blockchain is used since facilities and HMOs would need to be pre-registered/provided with authentication credentials before submitting data to the blockchain.
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(3)
Blockchain provides more sources of truth, and can be used offline. This is because all participants have a valid copy of the chain, it is easier to validate the truthfulness of transactions (rather than having a central entity to validate).
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(4)
Scalability will be a big issue since the chain will contain transactions by all patients in the locality,
Use Case 3: Design for a Patient Centric Health Information Exchange using Blockchain
In this workflow each patient will have his/her own blockchain recording all the transactions done in a health facility or with a healthcare provider. The blockchain will not store his/her health records, but rather it will only keep a pointer to the location of the associated health record. The health records will be kept in the Health facilities. Health facilities as participants in the blockchain will have a copy of the blockchains that are assigned to the patients.
Guide Questions:
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(1)
Who are the participants in the blockchain?
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(2)
What kind of blockchain design can be used?
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(3)
What are the potential issues in this design?
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(4)
Will the design scale up?
Suggested Answers:
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(1)
Patients, facilities (where the patients have been seen) are participants. Each patient has his/her own blockchain. Facilities have the blockchain of all patients that were seen in the facility.
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(2)
A private/permissionless blockchain may be used since each patient would be given credentials to his/her own blockchain, and facilities would have permissions when submitting data.
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(3)
The actual sharing of health data may be an issue since health data is not in the blockchain
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(4)
The design will scale up, since a blockchain will only increase in length, as a patient goes to a health facility. It is not expected that a lot of transactions will be stored in a chain since on average a person goes to a health facility only around 7 – 10 times a year. For each person, this amount of data is manageable.