Coding a Blockchain application for healthcare information exchange

Let’s take some sample code from the BlueMix site which was reposited on Github:

(https://github.com/hyperledger/fabric/blob/master/examples/chaincode/go/chaincode_example02/chaincode_example02.go)

And see if we can hack it into a healthcare information update chain. Daunting.

I believe this is js.Node . I've never done js.Node before.

/* TODO: BUT, HOW DOES THE LEDGER KNOW WHAT INFORMATION I AM TRADING?

In this example, I am simply coding the information into a variable that I trade into the blockchain.

So, I supposed that if we all agree on code standards (say HL7, C-CDA standards) then all we have to do is get the data in and out using C-CDA standards.

*/

We can just look at the beginning of this code and see that it will not help me with my goal.  It is informative though. This code trades quantities of only one asset.  It subtracts a qty from entity A and gives it to entity B , verifies the transaction, and closes the ledger state for these entitites. What I want to do is trade information. I want to add information to entity B (the patient) and credit entity A (the practice) for providing the information. (or maybe in "debiting" Practice A, I'm noting for the practice that it submitted the information) The code referenced above is strictly for an integer subtraction from one entity and addition to another entity. I'll search for another code example so that maybe I'll have a better starting place for modeling healthcare information exchange in the Blockchain universe.

Coding a Blockchain application for healthcare information exchange

Let’s take some sample code from the BlueMix site which was reposited on Github:

(https://github.com/hyperledger/fabric/blob/master/examples/chaincode/go/chaincode_example02/chaincode_example02.go)

And see if we can hack it into a healthcare information update chain. Daunting.

I believe this is js.Node . I've never done js.Node before.

/* TODO: BUT, HOW DOES THE LEDGER KNOW WHAT INFORMATION I AM TRADING?

In this example, I am simply coding the information into a variable that I trade into the blockchain.

So, I supposed that if we all agree on code standards (say HL7, C-CDA standards) then all we have to do is get the data in and out using C-CDA standards.

*/

We can just look at the beginning of this code and see that it will not help me with my goal.  It is informative though. This code trades quantities of only one asset.  It subtracts a qty from entity A and gives it to entity B , verifies the transaction, and closes the ledger state for these entitites. What I want to do is trade information. I want to add information to entity B (the patient) and credit entity A (the practice) for providing the information. (or maybe in "debiting" Practice A, I'm noting for the practice that it submitted the information) The code referenced above is strictly for an integer subtraction from one entity and addition to another entity. I'll search for another code example so that maybe I'll have a better starting place for modeling healthcare information exchange in the Blockchain universe.

Coding a healthcare application for Blockchain

I usually have to dive right in if I'm going to understand something.  So I found some sample code via IBM BlueMix to read through.

Here is the first application I will try to create:

1.) Identify a patient using a cryptographic entity identifier.  Imagine that I have an application on my phone. I used it to connect to the Blockchain Healthcare Network (BHN).  The first time I did this, it issued me my cryptographic identifier that I stored on an application on my phone.  We won't bother talking about how this is kept secure. That's for a later discussion.

2.) In the case of this example, the identifier I discussed above will simply be a hard-coded key that is provided by BlueMix.

3.) I pretend I am a healthcare primary care provider that has co-identified me when I came to the practice (e.g., I log into my phone, open my BHN key application, and show them my QR code and they scan it in.)

4.) They prescribe/order me to take 1 Ibuprofen

5.) I leave and the practice submits this new medical information to the BHN

And, it's a transaction for the ledger.

So, here are the steps I believe will happen:

1.) Practice entity identifier is submitted to the blockchain.
2.) My patient entity identifier is submitted to the blockchain
3.) The transaction is this:

• Credit Patient's ledger with an Active Medication called Ibuprofen, quantity 1
• Debit Provider's ledger which indicates the practice has issued the unfilled prescription
• Verify the transaction is legitimate (not sure how this part works but it uses hundreds of "volunteer" computers around the world who get a micro-fee for providing their infrastructure)
• Close the transaction for these entities

Simple, right?

Hypothesizing on applying Blockchain to healthcare

Okay, so it’s a ledger that's "secure" and "transparent". hmm. http://blogs.wsj.com/cio/2016/02/02/cio-explainer-what-is-blockchain/

I must come up with a transaction that adds from one side of the ledger to the other and/or subtracts from one side to the other.

Once the transaction is complete, I must make sure the ledger is reconciled and auditable.

How would we put this to use in healthcare?

I assume, possibly wrongly, that the transaction for healthcare would add to a person’s healthcare record or subtract from it.

In other words, I am adding healthcare information to Person A’s record and taking it from the provider that Person A saw?

I’m not sure that is correct but let’s try a use case.

Person A goes to Practice Z and is administered drug Ibuprofen.  My blockchain transaction would look like this: Add drug Ibuprofen to drug list ledger of Person A and subtract drug Ibuprofen from drug order list of Practice Z.

This doesn’t make sense to me unless the ledger already has a record of Practice Z’s drug orders. I think I may be hung up on my far distant knowledge of double-ledger bookkeeping. In double-ledger bookkeeping, every addition to one account must correspond to a subtraction from another account. This doesn’t seem like a starter.  Time to go back and do more reading.

Blockchain for healthcare data hypothesis

After reading a pitiful small amount about blockchain, I am proposing this hypothesis about how to use it for managing a nationally available,  secure healthcare record. Then I will do more reading and experimentation to disprove or not disprove my thesis.
Hypothesis: I can setup a demonstration blockchain economy that allows healthcare and patient entities to add to, decrement from, and audit (or read from) patient health records stored in a blockchain ledger.
Secondarily: it's all secure and robust
Thirdly: there's an easy way for a patient to provide his/her entity identity, securely with a token. Wow. Now we are stretching.

I am not the first to propose this use case, just the most ignorant.  Soon that will all change.