A revolution in health care is underway and it is altering decades of established medical practice. Clinical Health (HITECH) Act of 2009 and Affordable Care Act (ACA) in 2010 have significantly impacted the healthcare. In last 5 years, healthcare industry has witnessed a significant adoption of Electronic Health Records this has led to significant advancements in digitizing the care delivery systems in healthcare. Volume-based medical practices that depended on consultations, tests, prescriptions, hospitalization, procedures and medical devices are moving to personalized and participative care with an emphasis on outcome based models. The good news is that the wealth of available patient data can help achieve these goals by providing physicians and care givers with unprecedented insights and radically improve care delivery. But the silver lining has a grey cloud: Patient data is fragmented across systems and, to further complicate matters, is available in disparate formats. Progress in digitization in care delivery systems has created a growing demand for interoperability that not only support the care continuum but support healthcare in general. EHR interoperability is a critical and necessary step that needs to be taken by stakeholders for improving the healthcare, however interoperability has remained limited and have many challenges like lack of healthcare data standards, insufficient privacy laws, cost and trust among the stakeholders.
The Healthcare Information and Management Systems Society (HIMSS) has developed a definition of interoperability. As per HIMSS interoperability has three levels.
- Foundational – At this level Health Information Technology (HIT) systems exchange information without any ability to interpret the data.
- Structural - This is the middle layer that defines the data formats exchanged between HIT systems retaining syntactic meaning of the data.
- Semantics - This is top most layer, where HIT systems send and receive data, interpret data meaningfully using standardized codes.
For real machine to machine interoperability of EHR systems, it is important that system fulfill all the above requirements. In addition to above technical requirements, data privacy is a big concern among the healthcare stakeholders, hence any system supporting interoperability of EHR must support permissions, trust and data security.
Blockchain provides mechanism to anonymized data and ensure the data cannot be tampered with or forged. The Blockchain uses public key cryptography to create records that are time-stamped and immutable. Copies of these data records are stored across thousands of nodes on a digital network. Changing these records at each node becomes an impossible task and prohibitively expensive, making the records reliable. The trust network created in this manner is among the most attractive features of the technology
Progress in digitization of care delivery systems has created a growing demand for interoperability that not only supports the care continuum, but also supports healthcare in general.