Well known companies such as Deloitte and Accenture have also been involved in

Well known companies such as deloitte and accenture

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global launch. Well known companies, such as Deloitte and Accenture, have also been involved in designing blockchain enabled technology for health care data and medical records management. IV. C HALLENGES IN I NCORPORATING B LOCKCHAIN FOR EHR S S YSTEMS Despite the above advantages, Blockchain will not offer the complete answer for all tribulations of EHRs Systems in its current state. More specifically, we extracted four challenges that we discuss herein: Scalability and Performance : While we could envision the use case of storing the entire EHRs within a blockchain, large medical files (e.g. X-ray and ECG) are too large for direct storage. This challenge was discussed in [3] and [12] and continues to remain a challenge. In addition, within a blockchain deployment, the decen- tralization, consensus and provenance features imply that all blocks should be stored on every participating client node within a system. As the size of data will be on constant increase, a demand on every participating node will also increase in order to provide the necessary scalability. To illustrate this scalability issue, a miners full participation in the Bitcoin network requires the miner to download the entire Bitcoin ledger, which totaled over 184 gigabytes at the end of Q3 2018. In addition, the maximum transaction validation within the Bitcoin network is at 7 transactions per second, which increases the possibility of a performance bottleneck. The blockchain-based platform that holds significantly larger volumes of data has to be proven in production environments as of yet [12]. In [3], a possible solution to this challenge proposed to store large collection of medical data off the chain in a data repository called a “data lake”. This would still be secure as the blockchain layer would enforce the access control policy. In this framework, “the patient would still have control of who has access to the personal data in the data lake because the data would not be readable without the decryption key, which is stored on the patient’s blockchain account” [3]. Usability : The cryptographic concepts of Blockchain trans- actions will be unfamiliar to most people. In the context of medical records sharing, the proposed schemes from the extracted studies require patients to manage their key pairs (public / private) in order to provide cryptographic signatures, and authorize access to their medical data. That said, the fundamental complexity of managing the keys should be concealed behind web and / or mobile application with a user-friendly interface [3]. But this also opens the door to a potential security threat that we will discuss next. Self- governance poses another challenge if the patient is unable to approve necessary access permits. This may occur from simply the loss of personal keys to an acute critical illness such as Alzheimer’s disease. Also, in case of an emergency,
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the medical data should be accessed to a medical staff by invoking a procedure using a trusted party (e.g., governmental organization, or a close relative).
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  • Winter '17
  • Pro. James Abbakarr
  • Electronic health record

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