Technical Design and Development of a Self-Sovereign Identity Management Platform for Patient-Centric Healthcare Using Blockchain Technology
Keywords:blockchain technology, decentralized identifiers, healthcare identity, hyperledger, self-sovereign identity, verifiable credentials
Objective: Clinical data in the United States is highly fragmented, stored in numerous different databases, and are defined by service providers or clinical specialties rather than by individuals or their families. As a result, linking or aggregating a complete record for a patient is a major technological, legal, and operational challenge. One factor that has made clinical data integration so difficult to achieve is the lack of a universal ID for everyone. This leads to other related problems of having to prove identity at each interaction with the health system and providing basic information about demographics, insurance, payment, and medical conditions repeatedly. Traditional solutions that require complex governance, expensive technology, and risks to privacy and security of the data have failed to solve this interoperability problem adequately. We describe the technical design decisions of a patient-centric decentralized health identity management system using blockchain technology, called MediLinker, to address some of these challenges.
Results: MediLinker allows users to store their personal data on digital wallets, which they control. It uses decentralized trusted identity using Hyperledger Indy and Hyperledger Aries. Patients use MediLinker to register and share their information securely and in a trusted system with healthcare and other service providers. Each MediLinker wallet can have six credential types: Health ID with patient demographics, insurance, medication list including COVID-19 vaccination status, credit card, medical power of attorney (MPOA) for guardians of pediatric or geriatric patients, and research consent. The system allows for in-person and remote granting and revoking of such permissions for care, research, or other purposes without repeatedly requiring physical identity documents or enrollment information.
Conclusion: We have successfully developed and tested a blockchain-based technical architecture, described in this paper, as an identity management system that may be operationalized and scaled for future implementation to improve patient experience and control over their personal information.
Congress of the United States. H.R. 34–114th Congress: 21st Century Cures Act. 2016. Congress.org. Available at: https://www.congress.gov/bill/114th-congress/house-bill/34
Dankar FK, Gergely M, Dankar SK. Informed consent in biomedical research. Comput Struct Biotechnol J. 2019;17:463–74. doi: 10.1016/j.csbj.2019.03.010
Nakamoto S. Bitcoin: a peer-to-peer electronic cash system. Bitcoin; 2008. Available from: https://bitcoin.org/bitcoin.pdf, [cited 1 December 2021].
Azaria A, Ekblaw A, Vieira T, Lippman A. MedRec: using blockchain for medical data access and permission management. Proceedings 2016 2nd International Conference on Open and Big Data—Obd 2016. 2016:25–30.
Gordon WJ, Catalini C. Blockchain technology for healthcare: facilitating the transition to patient-driven interoperability. Comput Struct Biotechnol J. 2018;16:224–30. doi: 10.1016/j.csbj.2018.06.003
Kuo TT, Kim HE, Ohno-Machado L. Blockchain distributed ledger technologies for biomedical and health care applications. J Am Med Inform Assoc. 2017;24(6):1211–20. doi: 10.1093/jamia/ocx068
Mettler M. Blockchain technology in healthcare the revolution starts here. 2016 IEEE 18th International Conference on E-Health Networking, Applications and Services (Healthcom). 2016: 520–2. Munich, Germany; 14–17 September 2016.
O’Donoghue O, Vazirani AA, Brindley D, Meinert E. Design choices and trade-offs in health care blockchain implementations: systematic review. J Med Internet Res. 2019;21(5):e12426. doi: 10.2196/12426
Roehrs A, da Costa CA, da Rosa Righi R. OmniPHR: a distributed architecture model to integrate personal health records. J Biomed Inform. 2017;71:70–81. doi: 10.1016/j.jbi.2017.05.012
Liang X, Zhao J, Shetty S, Liu J, Li D, editors. Integrating blockchain for data sharing and collaboration in mobile healthcare applications. 2017 IEEE 28th Annual International Symposium on Personal, Indoor, and Mobile Radio Communications (PIMRC); 8–13 October 2017.
Zhuang Y, Sheets L, Shae Z, Tsai JJP, Shyu CR. Applying blockchain technology for health information exchange and persistent monitoring for clinical trials. AMIA Annu Symp Proc 2018; 2018: 1167–75.
Wong DR, Bhattacharya S, Butte AJ. Prototype of running clinical trials in an untrustworthy environment using blockchain. Nat Commun. 2019;10(1):917. doi: 10.1038/s41467-019-08874-y
Raghavendra M. Can Blockchain technologies help tackle the opioid epidemic: a narrative review. Pain Med. 2019;20(10):1884–9. doi: 10.1093/pm/pny315
Hughes F, Morrow MJ. Blockchain and health care. Policy Polit Nurs Pract. 2019;20(1):4–7. doi: 10.1177/1527154419833570
Khurshid A, Holan C, Cowley C, et al. Designing and testing a blockchain application for patient identity management in healthcare. JAMIA Open. 2021; 4(3) doi: 10.1093/jamiaopen/ooaa073
Texas Health and Human Services Commission. MPOA, Medical Power of Attorney. 2018. Available from: https://www.hhs.texas.gov/laws-regulations/forms/advance-directives/mpoa-medical-power-attorney, [cited 1 December 2021].
Khovratovich D, Law J. Sovrin: digital identities in the blockchain era. Github Commit by jasonalaw October. 2017, p. 17. Available at: https://github.com/WebOfTrustInfo/rwot3-sf/blob/master/topics-and-advance-readings/Sovrin--digital-identities-in-the-blockchain-era.pdf
Khovratovich D, Law J. Sovrin: digital identities in the blockchain era. Github Commit by jasonalaw October. 2017, p. 17.
Sovrin Foundation. Available from: https://sovrin.org/
Tobin A, Reed D. The inevitable rise of self-sovereign identity. The Sovrin Foundation; 2016;29(2016). Available from: https://sovrin.org/wp-content/uploads/2018/03/The-Inevitable-Rise-of-Self-Sovereign-Identity.pdf
Hyperledger Indy. Type: Distributed ledger software. Copyright © 2022 The Linux Foundation®. Available from: https://sovrin.org/wp-content/uploads/2018/03/The-Inevitable-Rise-of-Self-Sovereign-Identity.pdf
Hyperledger Indy. Type: Distributed ledger software. Hyperledger Foundation. Copyright ©2022 The Linux Foundation®. Cited, 12/1/21. Available from: https://www.hyperledger.org/use/hyperledger-indy
World Wide Web Consortium (W3C). Copyright © 2022 W3C®. Available from: https://www.w3.org/
React Native: Learn once, write anywhere. Cited: 12/1/21. Available from: https://reactnative.dev/
The React UI library you always wanted. React Native. Copyright ©2022 Meta Platforms, Inc. Cited: 12/1/21. Available from: https://reactnative.dev/
Merkel D. Docker: lightweight linux containers for consistent development and deployment. Linux J. 2014;2014(239):2.
Rhoades H, Wenzel SL, Rice E, Winetrobe H, Henwood B. No digital divide? Technology use among homeless adults. J Soc Distress Homeless. 2017;26(1):73–7. doi: 10.1080/10530789.2017.1305140
Raven MC, Kaplan LM, Rosenberg M, Tieu L, Guzman D, Kushel M. Mobile phone, computer, and internet use among older homeless adults: results from the HOPE HOME cohort study. JMIR Mhealth Uhealth. 2018;6(12):e10049. doi: 10.2196/10049
Menachemi N, Rahurkar S, Harle CA, Vest JR. The benefits of health information exchange: an updated systematic review. J Am Med Inform Assoc. 2018;25(9):1259–65. doi: 10.1093/jamia/ocy035
Wu H, LaRue EM. Linking the health data system in the U.S.: challenges to the benefits. Int J Nurs Sci. 2017;4(4):410–17. doi: 10.1016/j.ijnss.2017.09.006
Omar AA, Bhuiyan MZA, Basu A, Kiyomoto S, Rahman MS. Privacy-friendly platform for healthcare data in cloud based on blockchain environment. Future Generation Comput Syst. 2019;95:511–21. doi: 10.1016/j.future.2018.12.044
Dunphy P, Petitcolas FAP. A first look at identity management schemes on the blockchain. IEEE Security Privacy Magazine. 2018;16(4). doi: 10.1109/MSP.2018.3111247
Khurshid A, Gadnis A. Using blockchain to create transaction identity for persons experiencing homelessness in America: policy proposal. JMIR Res Protoc. 2019;8(3):e10654. doi: 10.2196/10654
Khurshid A, Rajeswaren V, Andrews S. Using blockchain technology to mitigate challenges in service access for the homeless and data exchange between providers: qualitative study. J Med Internet Res. 2020;22(6):e16887. doi: 10.2196/16887
Khurshid A. Applying blockchain technology to address the crisis of trust during the COVID-19 pandemic. JMIR Med Inform. 2020;8(9):e20477. doi: 10.2196/20477
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Copyright (c) 2022 Daniel Toshio Harrell, Muhammad Usman, Ladd Hanson, Mustafa Abdul-Moheeth, Ishav Desai, Jahnavi Shriram, Eliel de Oliveira, John Robert Bautista, Eric T. Meyer, Anjum Khurshid
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