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Thank you for joining.
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2. Welcome to the OSEHRA Innovation Webinar
Blockchain for Health Data
and its Potential Use in Health IT and
Health Care Related Research
Opening slide
Laure Linn
CTO, HyperLinkMed.com

3. HyperLinkMed ©

4. Agenda Bitcoin Philosophy Blockchain Concepts
Shared ledgers, Private vs. Public
Distributed networks
Consensus mechanisms
Immutability
Cryptographic keys and hashes
Block structure
End-to-End scenario
Advantages of blockchain
Advantages of blockchain for Health Care
Healthcare Blockchain Components
Blockchain with off-chain storage
Secure Identity
Access Control
Health Monitoring
HyperLinkMed ©

5. Bitcoin
Bitcoin was meant to be an alternative to our current financial system.
People used to pay each other in gold and silver however these mediums are difficult to transport and difficult to divide.
Paper money was invented and originally was a claim to gold in a bank vault. It is easier to transport and divide.
Banks printed money --- money no longer was backed by a claim to gold.
Its The market tanked and bitcoin originators wanted an alternative to financial institutions and hard currencies.
The bitcoin genesis block is labeled with the text:
“03/Jan/2009 Chancellor on brink of second bailout for banks.”
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6. Bitcoin Blockchain Concepts
distributed network
Shared ledger
immutable
Consensus mechanism
Cryptography
Consensus mechanism, proof-of-work, mining
HyperLinkMed ©

7. Transactions Contracts
Source: Blockchain Explained, An Introduction to Blockchain for Business v5.03, 24 January IBM Blockchain

8. Shared Transaction Ledgers
Each member stores an identical copy of the shared ledger
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9. Type of Ledgers

10. Types of Ledgers Anyone and everyone can participate
I need permission or approval to join
Anyone and everyone can participate
Source: Consensus-as-a-service: a brief report on the emergence of permissioned, distributed ledger systems
By Tim Swanson
Published: April 6, 2015

11. Key Concepts distributed network Shared ledger immutable
Consensus mechanism
Cryptography
Consensus mechanism, proof-of-work, mining
HyperLinkMed ©

12. Blockchains are distributed networks
Nodes are equal

13. distributed network
Shared ledger
immutable
Consensus mechanism
Cryptography
Consensus mechanism, proof-of-work, mining
HyperLinkMed ©

14. Challenge’s with Distributed Databases
Consensus
Challenge’s with Distributed Databases
If it isn’t centralized, you need a way to get consensus within the multiple parties about what transactions are valid and how transactions will be validated.
You have multiple copies of the database and each copy is performing writes. How do I keep these databases in sync?
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15. Lots of consensus algorithms exist
Consensus Mechanisms
Every member in the network uses the same consensus mechanism to verify every transactions made through the network
Lots of consensus algorithms exist
Understand your use case and the advantages / disadvantages of each mechanism

16. distributed network
Shared ledger
immutable
Consensus mechanism
Cryptography
Consensus mechanism, proof-of-work, mining
HyperLinkMed ©

17. Immutable There is no master database – everything is an equal node.
Everyone has to performs writes, and writes must occur and the end of the table – no time to split the data on an insert.
Facebook data structures are immutable - that’s the only way they could achieve screen refresh performance.
Immutability is a design pattern / principle for performance and for auditability.
HyperLinkMed ©

18. distributed network
Shared ledger
immutable
Consensus mechanism
Cryptography
Consensus mechanism, proof-of-work, mining
HyperLinkMed ©

19. Cryptographic Keys Transactions are digitally signed with keys
You must have the key to view the transaction

20. Cryptographic Hash
I CAN read this
I CAN’T read this

21. How does it work?
Data is stored in linked blocks
HyperLinkMed ©

22. Structure of the Block Chronological Order Link to the previous block
Multiple transactions in a block
HyperLinkMed ©

23. How does it work?
Image: Financial Times

24. Advantages for Health Care Data
Source:

25. Blockchain Opportunities in Health

26. Components based multi-blockchain architecture for a health care ecosystem
Secure
Identity
Health Information
Off-Chain Data Store
Access Control
Health Monitoring
Each component has a distinct purpose.
Best-of-breed solutions.
Leverage advances other industries are making in the space like FinTech.
Blockchain
Smart Contract
HyperLinkMed ©

27. Health Information & Data Store
Separate the metadata from the data
Health Information
Off-Chain Data Store
HyperLinkMed ©

28. Secure Identity
Secure
Identity
Digital ID would not contain any personally identifiable information and will provide identity anonymity to ensure data privacy and the safeguards required to secure medical information.
Digital ID would act as a digital watermark and be assigned to every online transaction of any asset including health information
Key Capabilities
Based on biometrics from DNA analysis, voice pattern recognition and iris scanning to establish a unique verifiable identity.
Creates a digital ID that contains no personally identifiable information.
Provide ability to digitally sign claims, transactions, and documents.
Interact with decentralized applications and smart contracts.
HyperLinkMed ©

29. Blockchain Attritutes Financial Industry Backing
Secure Identity
Secure
Identity
Several blockchain startups are looking to play a vital role in establishing a trusted digital identity that also protects consumer privacy
Blockchain Attritutes
Supported ID's
Security
Year Started
Blockchain Based
Type of Blockchain
Consensus Mechanism
Biometrics
Mutliple Types of ID's
Devices
Cloud Services
Keys
Financial Industry Backing
Identity Anonymity
Control Mechanism
ShoCard a
Public
Encrypted Hased
Uniquid
ChainAnchor
Private
Mining via verfied Identities
Anyone can read and verify transactions
Yoti
Velix.ID
Civic
HyperLinkMed ©

30. Access Control
Access Control
Used to help influence individuals and organizations to share their information with clear expectations of how that information will be used and protected, and be able to trust the information coming from other organizations.
Key Capabilities
Support access control rights through Attribute-Based Access Control (ABAC) policies.
Allow users to easily create precise access policies that contains the access rules and edge conditions.
Provide ability to combine a set of rules expressing conditions over a set of attributes paired to the subject, to the resource or to the environment.
Integrate with Secure Identity solutions.
HyperLinkMed ©

31. Access Control
Access Control
A rule may state that only authorized medical personnel shall be able to access a patient’s medical record.
In some system, if the object is a document with a Record Type Attribute of Patient Medical Record, then the Medical Record Rule will be selected and processed
Subjects with a Personnel Type Attribute value of Non-Medical Support Staff trying to perform the Read operation will be denied access and the operation will be disallowed.
Source:

32. Health Monitoring
Health Monitoring
Health monitoring rules are turned into a series of smart contracts that get triggered as health information is added to the blockchain.
Source:

33. Health Monitoring
Health Monitoring
Key components for a blockchain based solution for health care
Blockchain
Transaction
Created
Model
Triggered
Model Queries Blockchain
Patient Risk Score Generated
Outcome Predicated
Actions
Triggered
Diabetes patient blood sugar measured via personal wearable that creates blockchain transactions.
Blood sugar transactions triggers the diabetic
monitoring
Model.
Model gathers data that influences diabetic outcomes:
Age, Alcohol use
Annual eye exam
Annual foot exam
Average time between visits
Blood pressure
BMI
Model determines patient risk
Model predicates the unscheduled need for healthcare based upon a risk profiling
Health provider is notified to follow up with patient
Sources:

34. Thank you!
Questions?
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35. Thank You for Attending! Please visit us at HIMSS18
March 5 – 9, 2018
Exhibit Booth #10516
Level 1, Hall G
Venetian – Palazzo – Sands Expo Center
Las Vegas, Nevada