‘HIEofOne’区块链与医疗信息保护精修订.docx

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1、HIEofOne,区块链 与医疗信息保护集团标准化工作小组#Q8QGGQT-GX8G08Q8-GNQGJ8-MHHGN# Servero UMA Authorization Server Secure policy storeo Federated ID Client Support DIDOpenlD Connect Whitelist of federated ID providerso Privacy-related server software -. electronic health record o Protected attribute storeo Transaction r

2、eceipt storeSSST components will be provided by community-supported and commercial vendors: A mobile app to manage DID keys, biometric access controls, and key recovery. The online component of the SSST could be built from source, run as an executable from a trusted source, or outsourced to a servic

3、e 26. Attribute verification would be operated as a medical society member service.MedicalPharmacySocietyFig. 4 - The Value Propositions for Self-Sovereign Support TechnologiesWith reference to Figure 4: The Medical Society offers a valuable credentialing service to members without risk of patient d

4、ata breach.CC BY Please find this document at hBlockchainHealth9The Licensed MD has total control over her relationship with the patient and can practice to the full value of her professional license. The Patient can save money by choosing the pharmacy and can preserve privacy by working directly wi

5、th a physician. The Pharmacy, and other health services providers, can innovate and add value without the mediation of intermediary hospitals and EHR vendors. Suppliers of SSST to physicians and patients can add value as app developers and support organizations without patient lock-in or inserting t

6、hemselves into the institutional trust chain.The major benefit of self-sovereign support technology in this example is the re-decentralization of the trusted relationship between the physician and the patient. The full value of the medical consultation is now available to the two principal parties,

7、but each of them can manage their own policies to provide access to shared resources such as a physician directory or a pharmacy. A second benefit of this approach is security through diversity. All patients and all physicians can have different self-sovereign technology to support their security, p

8、rivacy and economic interests.Acknowledgements:Christopher Allen, Shannon Appelcline, and Rebooting the Web of Trust, Doug Schepers, Blockstack, Consensys, Evernym, YOTI, Eve Maier and the UMAnitarians, Philip Sheldrake and the hi:project, IIW, MITREID Connect, the VRM list, and the MIT Bitcoin Club

9、 as well as Michael Chen, MD who created and modified the open-source NOSH electronic health record and coded the UMA AS in support of our evolving proof-of-concept.References:1, connect/3. Verifiable Claims Use CasesW3c Editors Draft 22 June 20164. Blockchains and the Web Report5. shihjay2/hieofone

10、as6. NOSH Charting System7. &featue二CC BY Please find this document at hBlockchainHealthlO8. H. Le Van Gong, D. Balfanz, A. Czeskis, A. Birgisson, J. Hodges, FIDO : Web API for accessing FIDO credentials, World Wide Web Consortium (W3C) Member Submission, November 2015. web-api-/.9. Web Authenticnti

11、on: A Web API for accessing scoped credentialsW3c First Public Working Draft, 31 May 201610. User Managed Access:of One UMA Authorization Server17.18. wg/heart/19. certification/22.24. 10SovTech26. wg/heart/chartnr/CC BY Please find this document at hBlockchainHealthl 1Powering the Physician-Patient

12、 Relationship with HIE of One Blockchain Health ITAdrian Gropper, MDAugust 7, 2016Address whether there is a place in health IT and/or healthcare related research for the technology 1Physicians steer treatment together with patients and are responsible for the vast majority of decisions, and therefo

13、re expenditures, in healthcare. Yet the technology that mediates the physician-patient relationship today is not directly purchased or controlled by either the physicians or the patients. Electronic health records and health information exchange technology are sold as strategic assets to institution

14、s, typically very large businesses, that currently have incentives to maximize institutional growth. We seek a better balance of institutional needs with the needs of physicians and patients.It is widely accepted that reducing healthcare cost growth requires genuine practice reform. Few institutions

15、, however, are planning to reduce their own size. By focusing health information technology and interoperability on the physician-patient relationship we bypass the inertia of institutions, fertilize the environment for value-based payment, and optimize care options among hospitals, the community, a

16、nd home, as appropriate.Blockchain is widely recognized for its ability to empower innovators and individuals on a large scale in an environment that includes the necessity of institutions. The appropriate application of blockchain technology to health IT can shift the balance to the physician-patie

17、nt relationship. Ifs hard to imagine a more effective lubricant for innovation in our complex privatized healthcare system. Describe the value of Blockchain to the healthcare system?Blockchain has proven value at reducing transaction costs in trading systems and expanding the accessible market for i

18、nnovators. It does this by shifting power to the edges of the network - the consumers. This paper describes a standards-based way for blockchain to shift decision making and purchasing power to physicians and patients.Shifting control of health IT away from the hospital not only opens the market mak

19、ing it accessible to physicians and patients but it also opens the market for decision support at the point of care. For example, hospitals are reluctant to show physicians the cost of a medication or procedure when theyYe about to order it. They are even less likely to present the physician with a

20、list of alternatives. On the patient side, there5s no way toCC BY Please find this document at hBlockchainHealthl independently advise the patient of out-of-pocket costs, alternative sources, and typical risks while the patient and physician are engaged in making very costly decisions. Mobile device

21、s in the physician-patient encounter and secure blockchain infrastructure enable the next generation of decision support apps at the point of care.Our project, HIE of One, (Health Information Exchange of One) shifts the trusted intermediary role away from the hospital and into the blockchain. The bl

22、ockchain can also provide the link between physician credentials and patient identity.In the current health IT architecture, the hospital is responsible for both credentialing the individuals and securing the protected health information (PHI). In the HIE of One architecture, credentialing is done b

23、y institutions such as medical societies or state agencies that do not have or want access to PHL Identity of physicians and of patients is managed on the blockchain without placing any PHI on the blockchain. . Identity is a write-seldom-read-mostly application thafs ideally suited for the write sel

24、dom read mostly character of the blockchain where proof-of-work is only required to create or update an identity while use of the identity costs essentially nothing.) Finally, in the HIE of One model, the PHI stays in place wherever it was generated or is most convenient. HIE of One works with PHI i

25、n institutional EHRs, PHRs, regional health information databases, cloud wellness services, or the Precision Medicine Initiative.HIE of One links patient PHI to blockchain identities and blockchain identities to verified credential provider institutions that dont have PHI and dont want the liability

26、 of PHI. This not only lowers transaction costs but it improves security for all participants. Data moves under the control of blockchain-mediated identity and trust. Identify potential gaps in standards created and/or resolved by Blockchain?Practices that protect patient privacy have not kept up wi

27、th the scale of todays hospital and HIE networks. When 5 or 10 Million patients and 50,000 staff have access to a single EHR system or delivery network, standards for consent, authorization, single-sign-on, and accounting of disclosures have proved elusive. At a national scale like the Precision Med

28、icine Initiative, todays practices are insufficient.High-level panels including PCAST and JASON concluded that separating access control from PHI stewardship will be necessary to achieve interoperability at scale. But this goes against the current role of hospitals as combined holders and controller

29、s of PHI. The gaps in current standards are not incidental. They are the result of an imbalance of IT purchasing power in favor of hospitals and their EHR vendors.CC BY Please find this document at hBlockchainHealth2Another obvious gap is the lack of identity standards in healthcare. There is essent

30、ially zero adoption of identity federation (single sign-on) for either physicians or patients. In addition, identity matching seems to be a problem unique to healthcare and has spawned expensive and unreliable probabilistic methods that harm privacy and will not scale to the needs of a nation.Blockc

31、hain has some established identity standards to the extent that it is able to reliably maintain the integrity and accessibility of individual (wallets but there are gaps in linking the cryptographic identity of blockchains to single-sign-on standards like OpenlD Connect 2 and to verified claims 3.HI

32、E of One is working with multiple blockchains under the auspices of the World Wide Web Consortium (W3C) to advance blockchain ID standards 4 and to align them with the OpenlD Connect capability already in HIE of One 5 and our FHIR-standard EHRs 6. The initial demo of HIE of One based on HL7 FHIR - O

33、penlD Connect - Kantara UMA standards was made to the OpenlD HEART workgroup in February 2016 7.To fill the blockchain identity standards gap we are now working with the W3C Web Authentication 8,9 and W3C Verifiable Claims 3standards workgroups along with the W3C Blockchain Community 10 group and co

34、ntributing to the HL7 FHIR 11 standards and UMA VZ development as well. This work will be presented at the Rebooting the Web of Trust meeting at the end of October 2016 13. Discuss the effectiveness of Blockchain to function in the “real world.”The effectiveness of managing blockchain private keys h

35、as had a great deal of “real world” experience because it is the core of blockchain wallet functionality. The use of private keys for identity authentication has been shown at scale by the FIDO Alliance products and is being adopted as WebAuthn / FIDO by the W3C 8,9.The effectiveness of managing blo

36、ckchain identity in the “real world“ has not been established but second-generation systems already exist and two vendors (one Bitcoin and the other Ethereum based) have been selected for integration with the Microsoft Azure cloud platform 14. Blockchain ID has been broadly available for over a year

37、. 15The HIE of One system W does not store or manage PHI on the blockchain. Thus, it avoids serious privacy and scalability issues with blockchain technology. The HIE of One system uses FHIR 11, OAuth2 17, and UMA 12 together as in HEART W toCC BY Please find this document at hBlockchainHealth3 secu

38、re and manage access to PHI. Although FHIR and UMA are young, the effectiveness of these standards in the real world is not in doubt 19.The link between the user ID (physicians and patients both) and the PHI is managed by OpenlD Connect in HIE of One. The effectiveness of this approach has had exten

39、sive real-world proof by Google 20 and many others 21.In summary, the HIE of One approach uses blockchain conservatively for ID only and leverages the vast experience with OAuth2 and OpenlD Connect to minimize the deployment risk. Blockchain ID is very low cost, on the order of pennies for account c

40、reation or changes of key attributes. Because our approach to PHI management does not modify the blockchain at all, it adds no proof-of-work cost and is therefore as cost-effective as any FHIR / OAuth data management scheme. HIE of One transaction costs will benefit from the large-scale of FHIR APIs

41、 in general in a way that proprietary PHI management APIs on or off the blockchain cannot. Discuss how Blockchain links to the stated objectives and national priorities.Blockchain links the stated objectives in the Nationwide Interoperability Roadmap, PCOR, PMI, delivery system reform, and other nat

42、ional healthcare delivery priorities by enabling patient-directed exchange in a cost-effective and scalable way.PMI, PCOR, and the Nationwide Interoperability Roadmap already recognize the need for patient-directed exchange. Delivery systems reform is not directly associated with patient-directed ex

43、change, but HIE of One uses blockchain to put control of interoperability and decision support at the point of care in the hands of patients and physicians. As discussed at the beginning of this paper, this shift of control away from hospitals will lubricate delivery systems reform through competiti

44、on and the reduction of transaction costs on a national scale. HIE of One Self-Sovereign ID InnovationThe current generation of standards-based identity providers (IdP), like Google and upcoming EHR FHIR implementations, manage user authentication and reputation together in one responsible instituti

45、on. This makes the IdP bear the risk of a security compromise that exposes PHI resources and it requires the federated institutions to “trust” the IdP, often a competitor. A self-sovereign ID would enable verifiable reputation and attributes of physicians and patients without any institution bearing

46、 the risk of user authentication. Management of the private key used for authentication is entirely underCC BY Please find this document at hBlockchainHealth4 the control of the individual person and supports the strongest levels of non-repudiation including recently adopted EU e-IDAS regulations 22

47、. With self-sovereign ID, the trust of a relying party is directly linked to an individual persons control of a secure element without any institutional intermediary. The power of this approach has already been shown by non-institutional trust systems like Bitcoin and FIDO 23.Permissionless distribu

48、ted public ledgers, like Bitcoin and Ethereum, can replace some aspects of institutional trust with cryptography. In particular, a person in control of his/her private key (in the e-IDAS sense of non-repudiation of control) can authenticate themselves with a high level of assurance if the private ke

49、y can also be associated with a trusted reputation mechanism. This paper explores the application of blockchains in support of more complex transactions where the participants have reputation or a verified attribute and the information exchanged is private.We use a licensed MD writing a prescription as an example transaction. Aside f