[DG-BSC] Sedona EHR Use Case fails in terms of how individuals interact more equitably and efficiently

Adrian Gropper agropper at healthurl.com
Tue Jan 3 11:09:37 CST 2017


When the individuals involved are a licensed professional and a patient,
the Logical Model (p62) makes almost no sense at all.

The EHR could be compiled from source and patient owned as long as:

(1) the licensed professional's claims can be verified by the patient
against their issuers

(2) the licensed professional can put a digital signature on a detailed log
entry created by the EHR

(3) the timestamped hash of the log entry can be put on a distributed
public ledger

(4) the licensed professional may keep a copy of their log entry and the
timestamp proof in case of dispute where the patient "loses" their copy.

An effective individual-centric solution depends on substitutability and
therefore standards. There are standards being worked on for many of these

(1) W3C Verifiable Claims https://www.w3.org/2017/vc/charter

(2) Rebooting Web of Trust Decentralized Identifier (DID
is being implemented by 4 separate groups

(3) Chainpoint http://www.chainpoint.org/  and Open Timestamps
<https://petertodd.org/2016/opentimestamps-announcement> are being combined
in Rebooting Web of Trust

(4) is just a personal data store like Dropbox

The HIE of One Use Case and reference implementation http://hieofone.org/ is
in the process of implementing this whole stack.

(a) The patient-controlled EHR is done.

(b) The patient-controlled controller of the EHR and other resources is a
personal UMA AS and is done.

(c) The physician's DID and secure signature are initially demonstrated
using uPort
and being upgraded and integrated.

(d) Verifiable Claims is not yet implemented. The Use Case paper
won an ONC Blockchain Health prize.

(e) Timestamps of the physician's interaction with the EHR are not yet

I believe this shows a licensed individual writing a prescription or
curating a patient-centered longitudinal health record in the absence of
any particular federation or trust framework.



Adrian Gropper MD
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