[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


https://s3.amazonaws.com/IGG/EHR.pdf


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
steps:

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

(2) Rebooting Web of Trust Decentralized Identifier (DID
<https://github.com/WebOfTrustInfo/rebooting-the-web-of-trust-fall2016/blob/master/draft-documents/DID-Spec-Implementers-Draft-01.pdf>)
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
<https://www.youtube.com/watch?v=FNlAkGauIdw&list=PLn9P7BiqUmmjk09q4I57cvPwysvsScm1p&index=6>
and being upgraded and integrated.

(d) Verifiable Claims is not yet implemented. The Use Case paper
<https://www.healthit.gov/sites/default/files/7-29-poweringthephysician-patientrelationshipwithblockchainhealthit.pdf>
won an ONC Blockchain Health prize.

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


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


-- 

Adrian Gropper MD
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