From more efficient processes to a faster exchange of information and a higher quality of medical care: the electronic patient record has enormous potential – both for patients and for the entire health sector. The fifteen-year-old concept that is currently being implemented is technologically outdated and vulnerable to security standards. Patients also do not receive the necessary sovereignty over their personal data.
Reason enough for the politically responsible and actors in the healthcare industry to cut off the old braids and take into account new technological possibilities – such as blockchain technology and decentralized storage systems.
It has been fifteen years since the federal government decided to introduce an “electronic patient record” (ePA). It will be available to all patients from January 2021 and will be introduced across the board. The health insurance companies that are responsible for the implementation are working flat out on solutions for their insured. The goal: digitally bundle health-related data and link patient information between doctors, nursing facilities or pharmacies via the so-called telematics infrastructure (TI).
However, the concept presented has two major weaknesses: An electronic “file” with centrally stored data does not meet the requirements for data security and sovereignty – not to mention today’s technological reality. What was still a visionary thought 15 years ago has long since become technically out of date. Before the electronic patient record even starts, it is no longer up to date. Nevertheless, those responsible persist in their plans – despite all concerns.
A key weak point of the planned electronic patient record is the central storage of highly sensitive data on central servers – a daring and hardly irresponsible undertaking. The telematics infrastructure provides for copies of patient data to be stored on a central memory. Central storage systems are susceptible to data loss – up to data misuse and theft. It should be clear to everyone what the loss of personal medical data would mean for trust in the healthcare system. It is also clear that sovereignty over data in central storage systems is always in the hands of the respective managing organization and not where it belongs: with the patient.
The electronic patient record is intended to be a source of information and work equipment for a large number of user groups. This includes:
and research institutes.
They should all be given the opportunity to access the central data store. Many distributed users with different access scenarios: This is an almost perfect requirement for decentralized storage systems, such as IPFS – the interplanetary file system. At IPFS, data fragments are distributed over a large number of nodes in a peer-to-peer process and are continuously replicated. This ensures that data is never lost and is always available. And: The more participants are in the network, the greater the data security.
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It is difficult to understand why none of the currently tested offers makes the step towards decentralized storage options and an insufficient level of data security and sovereignty is accepted.
The decentralized storage of patient data is one side of the coin. The other side is the blockchain. A blockchain is a continuously expandable list of transaction data that are linked together using cryptographic methods. In the case of a decentralized patient record, the blockchain acts as an audit-proof data register. While the data itself is stored in a fragmented, decentralized manner, it could be anchored on a blockchain how all the data is put together to form the current version of a patient record.
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The blockchain approach increases data security enormously. Changes to the data on the blockchain are only possible if the participants agree, in this case the patients themselves. This is not only safer, but also more practical and takes into account the fact that many actors need (partial) information about the patient’s data have, but only the patient should decide on their disclosure.
In this way, patients become the real sovereignty over their own data – which, given the fact that it is their own medical information, is the only correct approach. The patient becomes the owner of his digital patient record. He creates it, checks its content, can add information and share it with the players of his choice.
Blockchain technology can provide a future-proof answer to the most urgent problems surrounding the electronic patient record. It increases data security and enables the ePa to become a patient-oriented networking tool for the health sector. Even if the legal framework is largely clear and the current concept is in the process of implementation: it is not too late to think about current technological approaches, to try them out in a real environment and to implement them for future solutions. (bw)