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Background

Emory has started exploring potential use cases for blockchain technology in healthcare and health sciences research. The purpose of this page is to capture these use cases in detail and enumerate potential technical proofs-of-concept worth exploring. Current participants working on these use cases and potential technical implementation descriptions are:

  • Lydia Fazzio, MD Emory Healthcare
  • Tod Jackson, IT Architecture Technical Lead
  • Steve Wheat, Chief IT Architect

Presently the group is documenting potential use cases, the technical infrastructure required to implement them, and discussing Emory security and compliance policy implications with Compliance and Information Security Officers to understand how Emory's policies apply to these use cases and this technology or how they might need to evolve to address them.

If you would like to contribute, just send a request to swheat@emory.edu to be added to the page.

Blockchain Technology

A blockchain is a distributed or redundant database used to maintain a list or records known as blocks. A blockchain is typically maintained by a peer-to-peer network. Blockchain technology implements high-profile cryptocurrencies like Bitcoin and distributed computing platforms such as Ethereum. There are emerging healthcare and research applications of blockchain technology, because it enables inherently secure, distributed databases which can cut across traditional organizational boundaries to enable data sharing that has been challenging or impossible with traditional centralized, organizational computing. A blockchain can be used to store data securely and privately in a publicly accessible, distributed database.

Figure 1: Blockchain Background Video from Hashed Health

Use Cases

Case 1: The Portable Medical Record for the Homeless

Problem: homeless patients frequently move and get their care in many disparate healthcare facilities; often these records are inaccessible ; this poses a problem when they present to Emory for care

Homeless, uninsured patient comes to the emergency room with chest pain, alcohol intoxication and a seizure disorder. He does not remember the name or doses of his medications, the name of the doctors who are prescribing his meds, nor the last time he had lab work or what the results were. He lives in a shelter and had his belongings stolen. Luckily, he has his feature phone in his pocket. He grants permission to the emergency room doctor to scan the QR code on the phone that gives only that physician access to his health record on the blockchain. This QR code contains a private key that allows the doctor unlock and access the relevant info on the blockchain ; this interaction is also logged on the blockchain. The physician is then able to safely treat the patient and coordinate care.

References: Hashed Health | Patientory Whitepaper  Add | More | Reference | Links | Here

Case 2: Tracking Controlled Substances Across State Lines

Problem: opioid  and benzodiazepine depenent patients frequently doctor shop across state lines and there is a huge problem of diversion of prescriptions for illicit use; in July 2018 all physicians in GA are mandated to register with the GA database to track opioid and benzodiazepine prescriptions; however they can search controlled substance prescribing data only within GA; this gives Emory physicians a potentially inaccurate view of a patients opioid/benzodiazepine use history leading to potential for continued opioid diversion

Female patient presents to the clinic requesting a refill of her opioid medications for chronic back pain. She says she is from out of state and someone stole her prescriptions on the bus. The doctor seeing the patient is verified as a registered user of the GA Prescription Drug Monitoring Program which grants permission for the Doctor to looks up the patient on the Emory Opioid Tracking blockchain ; the doctor finds that she has been to 5 other clinics across the southeast with the same complaint in the past month.

References: Opioid Distributors Under Scrutiny | GA Senate Bill 81 | GA Prescription Drug Monitoring Program  | Reference | Links | Here

Case 3: Electronic Medical Record Interoperability

Problem: Many patients get medical care from both Grady and Emory Midtown; Physicians at Emory Midtown are unable to access medical record information on the Grady system due to interoperability incompatibilities

Physician at Emory Midtown hospital sees a patient who was recently discharged from Grady. The patient provides the physician with her private key on her cellphone or gives the physician her Emory Smart Card [ a card with a type of smart chip]. She then opens the FHIR blocks app on her mobile device which allows her to scan the QR code or insert the card into her card reader allowing her to access the patient's discharge summary from Grady.
References: Potential for Blockchain to Transform Health Records | Smart Card Alliance | More | Reference | Links | Here

Case 4: Wearables and Smart Contracts for Patient Reminders

Problem: Older patients have a hard time keeping track of multiple medical appointments ; they often need to track heart rate and glucose  but are often limited in remembering relevant aspects of their care; when they see the doctor, they often provide incomplete symptom/medical data which often that limits effective care

Elderly patient has five upcoming doctors appointments for treatment of her multiple medical problems.  She is part of an Emory pilot program that provides her with a wearable that tracks steps, monitors her heart rate and is connected to her glucose meter that monitors her blood sugar readings ; the patient has previously granted permission to specific doctors in her network to access her device data and scheduling information. Her monitor notices an unusually slow heart rate, this activates a smart contract in the Blockchain EMR and triggers a reminder to visit her cardiologist and schedules the first available appointment, additionally, a smart contract is activated for a followup endocrinology appointment when her glucose monitor registers a series of abnormal values. Both values flow into the patient's blockchain EMR and can be accessed by doctors the patient has granted permission to access her wearable device info.

Technical Infrastructure

At a high level, all of these use cases would be implemented by either storing data and smart contracts on an existing general or special purpose blockchain based on technology such as Ethereum or setting up a new blockchain for participating users. The second piece of these solutions are the mobile and web applications that access that blockchain.

References for existing general and special purpose blockchains: Patientory White Paper| MIT MedRec Prototype | Links | Here

[describe high-level technical implementation details by case]


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