Developing a Structural Standard for Smart Contract Electronic Health Records Based on the HL7 Fast Healthcare Interoperability Resources
Abstract
Electronic health records (EHRs) are becoming more essential to patient care, as they provide information that is usually valuable for health and medical decision-making. Each EHR typically comprises validated data provided by medical professionals during patient care and personal health data recorded by the individual patient. Existing implementations of EHRs, however, are often siloed and managed by disparate organizations. Health information exchanges, which aim to interoperate EHRs by different health organizations, are also primarily centralized and can be vulnerable to attacks such as distributed denial of service (DDoS) and data breaches. Blockchain is a potential solution to solving some of the current issues in health information exchange implementations. Smart contracts deployed on blockchain networks can help enforce appropriate health and medical record-keeping and sharing standards. This study aims to create a blockchain-based implementation that allows decentralized EHRs. Smart contracts were developed based on the Health Level 7 Fast Healthcare Interoperability Resource (HL7 FHIR). Experiments were designed and simulated on a local Ethereum blockchain network where 10,000 (generated) patients’ records were processed for evaluation. The results show that a structural standard can be applied to EHR smart contracts, but while blockchain solutions for EHR systems may be expected to be less vulnerable than centralized systems, the gas costs in Ethereum are potentially prohibitive and should be carefully considered.
