The term Health Information Exchange (HIE) is used to describe the fluid movement of patient health data across various platforms. The first and foremost function of an HIE is to grant permission to a patient’s clinical information on demand. “
According to an American Health Information Management Association report.
“A successful HIE depends on trust between the patient, the healthcare provider and the HIE. In order to build trust, HIEs must develop and implement policies and procedures guiding their operations, including how they will maintain and secure protected health information.”
Current Scenario of Information sharing in the Healthcare Sector
Electronic health information exchange (HIE) make room for doctors, pharmacists and other healthcare providers along with the patients to appropriately access vital information and securely share critical details. This will likewise improve the speed and costs associated with patient care.
However, HIO model of the commercial space does not have the provision for the patients to make a profit from sharing the information. Hence, HIE is not seen as an entity but rather a simple data sharing activity.
In most of the frameworks, the typical Health Information Exchange activity falls into both HIO and HIE definitions. Here, the data link sold to the purchases (internal or outside organizations) is not patient-driven as the model does not benefit the patients.
The types of HIE and Development Stages:
|Public Health Reporting Using HIE||Here, we utilize the HIE to transfer data to public health entities, which depends upon the HIE model being employed.|
|EHR-Based Information Exchange||Reporting in an EHR-based exchange is a direct electronic connection which is usually done manually unless a direct connection is established between the EHR-based exchange and the public health department.
Here, any modification in the data is by considering human and monetary resources.
|HIO Model Exchange||Here, all the information transfer takes places electronically where each provider builds a link to the HIO and where all the data is redirected. The existing model is entirely centralized.|
HIE experts consider a three-stage development in planning the commercial health information exchange:
- “Record and Playback” stage
- “Local Limited HIE” stage
- “Full Station” stage
However, to best serve the community it is vital to include stakeholders early in the process where everyone gets to know each other. As a result, a transparent design system is established alongside the policies, procedures, and agreements. However, to do so there is a need for blockchain integration.
Working of the HIEs
The sharing of medical data is usually done using email or fax between different providers, this is further carried by the patients for appointments. The HIE cannot replace the traditional provider-patient communication, however, it can improve the completeness of patients’ records. The past medical history and other critical information are jointly be reviewed by everyone in the loop.
Cross-institutional sharing of this critical information allows the providers to avoid readmissions and medication errors thereby decreasing duplicate testing.
Cross-institutional sharing of this critical information allow the providers to avoid readmissions and medication errors thereby decreasing duplicate testing.
However, there are concerns surrounding the entire ecosystem, here are few insignificant barriers:
 The institutions often are reluctant to share data because of malware and privacy concerns as they fear that the information being shared might give others a competitive edge
 Even if the privacy concerns are addressed, the broad consensus around the technical infrastructure that supports it is usually missing
 Sharing of this information requires a mutual understanding between all the parties involved so as to share it efficiently and securely. These interoperability issues when left unchecked are most likely to limit the utility of data as expected.
 The most critical issue arises when a party fails to secure the patient data, it leads to financial and legal consequences as information misconduct might impact patient care.
As said by Farzad Mostashari, the former national health IT coordinator for the Department of Health and Human Services (HHS),
“Health information exchange will not become a reality as a single vision or system but instead include many models and business plans. The evolving HIE vision must be built around standards, directories, participation agreements, governance models, and a clear understanding of different ways that information can be shared and understood.”
The major concerns surrounding privacy and security in existing HIE model include:
- Hacking attacks
- Data availability
- Trust and access control
- Confidentiality of PHI and PII
- Privacy regulations
How blockchain addresses these concerns:
Blockchain for healthcare guarantees to ensure cost-efficiency and accountability in managing sensitive health-related data transactions.
Here, the Bit-string cryptography maintains the data integrity without violating HIPAA (the Health Insurance Portability and Accountability Act), thereby limiting the real-time use and misuse of health information.
- The chain nodes which are in majority corroborates transaction validity through consensus
- Smart contracts notarize each transaction in the healthcare network
- Those providing services can track and update their patient’s health data, that includes prescriptions, clinical notes, the care plan along with lab results, etc. whilst maintaining the data security.
The need of Blockchain in Health Information Exchange
What needs to be focused here is privacy and anonymity and how it is being applied to data sharing. Data privacy in true sense must ensure that only the authorized parties must have the access to the critical information as the patient is not just the sole ethical responsibility but also a legal mandate.
Blockchain brings a democratized health and wellness ecosystem in the entire exchange process and the patients can self-govern data to gain access to better healthcare.
The decentralize medical health data will only grant access through smart contracts making the entire ecosystem secure and fair. The blockchain for healthcare data is directed towards a meaningful use of thought healthcare. With this, the patients get therapy focused conversational engagement layers that are supported by IOT devices and various medical pharma thumbprints.
The Transaction Process for Health Exchange in Blockchain
The blockchain technology in healthcare and EHR systems offers a holistic solution that enables the safe and secure exchange of to get over the usual incompatibilities at the provider level. Here, every health record, every medical device, and every wearable is a part of the blockchain network. As a matter of fact, it is self-explanatory that no one can alter the EHR blockchain record.
Firstly, the entire blockchain network focuses on user-patient satisfaction by incentivizing the platform making the offerings lively and dynamic. Also, tokenization ensures that every patient has the opportunity to earn and be rewarded for sharing health-related information. The blockchain ecosystem revolves around the use of tokens
Using Tokens in a Blockchain Network
In a blockchain for healthcare network, Tokens are used by the patients to pay for hosting and storage of their records. Everyone gets paid into this network right from pharmacists to the doctors for remotely reviewing patients’ medical information and providing consultation. Patients, on the other hand, also have the upper hand and gets paid in terms of token for sharing their healthcare data. Here, content is the King and distribution is the queen.
A unique digital signature will allow all the stakeholders to access the data and transact. The blockchain for healthcare streamlines the entire process when certain criteria are met for the Smart contracts to proceed further.
This is the usual transaction process:
Once the data is generated by the patient’s wearable device (watch, shoes etc.), the doctor writes a note to the blockchain. Soon after, the pharmacist dispenses the medicine as per the subscription.
- The data encrypted is sent to cloud storage
- As soon as the data is fetched, the blockchain ID retrieves the encrypted data.
- The decrypted data is finally displayed on the device
Blockchain technology is capable to track and timestamp each activity related to the patients’ critical data. It provides a permanent audit trail whilst ensuring the updated version of the record is put to use.
Finally, healthcare providers reward the patients with the token in exchange for accessing critical health information. Eventually, this change will allow stakeholders to see how the HIO can transform health care quality along with the overall efficiency of healthcare. Moreover, the blockchain for healthcare makes it possible for the providers to create a positive belief that the procedures and technical infrastructure they are providing are backed by security and limited interruptions.