The proper management of healthcare data is a complex endeavor that needs to balance the requirements and interests of many stakeholders. Previous research has identified and detailed many innovative blockchain-based use cases, but the current state of healthcare data management is still far from perfect. In this paper we present the findings from a panel discussion with healthcare professionals, who elaborate on the current situation in healthcare data management as well as the future role that blockchain can play in this sector. Based on the findings of this panel, we structure the research field of healthcare data management in a comprehensive framework and provide numerous avenues for future research. The outcome is a framework that highlights the important role of patients and their sensitive data, structured into several areas. From a patients’ perspective, we specifically elaborate on trust and privacy as well as the expected benefits. Additionally, four important data properties are identified: integrity, security, sharing and transfer, and interoperability. We outline the importance of the respective areas and derive several timely and important research questions that form the foundation of a future research agenda for blockchain-driven innovation in healthcare data management.

The author posits that the establishment of a blockchain-based health data marketplace where EHR, IoMT, and wearable-derived data can be monetized by selling it to data consumers like medical professionals, researchers, regulators, third-party (e.g., AI service providers) and policymakers can solve this data centralization problem.

Panelists discuss blockchain technology use for electronic health records, and specifically delve into the benefits that blockchain brings to EHRs, but also discuss what its pitfalls and limitations are; including presenting perspectives from academia, and examplesfrom practitioners. Learning Objectives Understand the potential applications of blockchain for electronic health records (EHRs). Explore the benefits and challenges of implementing blockchain for EHRs, including security, interoperability, privacy, and data integrity. Identify key use cases and real-world examples of blockchain implementation in healthcare and EHR management. Analyze the potential impact of blockchain on improving healthcare data exchange, patient consent management, and medical research. Discuss the regulatory and legal considerations associated with using blockchain in healthcare, such as compliance with data protection laws and standards. Examine the role of smart contracts and decentralized applications (DApps) in enhancing EHR management and patient control over their health information. Assess the scalability and performance limitations of blockchain technology in handling large-scale healthcare data and high transaction volumes. Evaluate potential cost savings and efficiency gains achieved through blockchain implementation in EHRs, considering factors such as data access, auditability, and administrative overhead. Discuss the future prospects and challenges of integrating blockchain with existing healthcare systems, standards, and infrastructure to achieve widespread adoption and interoperability.

Speakers delve into and beyond the previously published BHHTY journal article “Moving Beyond Proof of Concept and Pilots to Mainstream: Discovery and Lessons from Blockchain in Healthcare,” located at https://doi.org/10.30953/bhty.v6.280. This continuous enterprise blockchain technology journey extends the framework and solution assemblies including further developments, with cross over into generative AI and ethics. Objectives Learn specific examples on the economics of blockchain revealing low-hanging fruit for the move from pilots to adoption. Explore concepts such as: Data integrity, minimal data, inter-entity streamlining leading to efficiencies, and what is already possible with tech stack developments and economics in efficiency (in millions) from the previously published BHTY article at DOI: https://doi.org/10.30953/bhty.v6.280 Learn from other verticals to build a framework that is more comprehensive encompassing global perspectives Future proofing and stair-stepping design for an evolving technology – holistic guidance to find and execute the opportunities Obtain a framework for blockchain adoption based on the article. In addition, authors address the academic view of blockchain adoption, and that it is a combination of tech, policy, economics, consumer engagement, and operationalization. Acquire multi-dimensional discovery and specific blockchain constructs including provenance- consensus, trust maps, convergence, dApp human loops, and future proofing /stair-stepping Grasp global perspectives on evolving frameworks with in many verticals and the multi-dimensional nature of blockchain transformation, operationalization, blockchain-enterprise landscape, and AI automation. Gain a better understanding of why is blockchain an essential technology for the future of responsible AI and for scalability of solutions

The annual ConV2X is a leading international health tech symposium driving real world evidence, strategy, research, operations and trends to create a blueprint for a new digital health era. The 2021 symposium featured a scientific program of academic/research presentations in addition to business and industry talks. The research track focused on exploring and sharing developments in blockchain and emerging technologies in health and clinical medicine. Submissions were based on original research, conceptual frameworks, proposed applications, position papers, case studies, and real-world implementation. Selection was based on a peer-review process. Faculty, students, and industry researchers were encouraged to submit abstracts to present ideas before an informed and knowledgeable audience of industry leaders, policy makers, funders, and researchers.

This presentation was selected by the scientific review committee.

Submission Review Committee

• Dave Kochalko, CEO of ARTiFACTS
• Anjum Khurshid, UT Austin
• Carlos Caldas, UT Engineering
• Gil Alterovitz, Harvard Medical School
• Kayo Fujimoto, UT Health Houston
• Lei Zhang, University of Glasglow
• Sean Manion, CSciO of ConsenSys Health
• Vijayakuman Varadarajan, University of South Wales
• Vikram Dhillon, Wayne State University
• Yuichi Ikeda, Kyoto University

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. Design: Our multi-disciplinary research group developed and implemented an identity wallet, that uses blockchain technology to manage verifiable credentials issued by healthcare clinics, banks, and insurance companies. To manage patient’s self-sovereign identity, we leveraged the Hyperledger Indy blockchain framework to store patient’s decentralized identifiers (DIDs) and the schemas or format for each credential type. In contrast, the credentials containing patient data are stored “off-ledger” in each person’s wallet and accessible via a computer or smartphone. We used Hyperledger Aries as a middleware layer (API) to connect Hyperledger Indy with the front-end, which was developed using a JavaScript framework, ReactJS (Web Application) and React Native (iOS Application). 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.

The annual ConV2X is a leading international health tech symposium driving real world evidence, strategy, research, operations and trends to create a blueprint for a new digital health era. The 2021 symposium featured a scientific program of academic/research presentations in addition to business and industry talks. The research track focused on exploring and sharing developments in blockchain and emerging technologies in health and clinical medicine. Submissions were based on original research, conceptual frameworks, proposed applications, position papers, case studies, and real-world implementation. Selection was based on a peer-review process. Faculty, students, and industry researchers were encouraged to submit abstracts to present ideas before an informed and knowledgeable audience of industry leaders, policy makers, funders, and researchers.

This presentation was selected by the scientific review committee.

Submission Review Committee

• Dave Kochalko, CEO of ARTiFACTS
• Anjum Khurshid, UT Austin
• Carlos Caldas, UT Engineering
• Gil Alterovitz, Harvard Medical School
• Kayo Fujimoto, UT Health Houston
• Lei Zhang, University of Glasglow
• Sean Manion, CSciO of ConsenSys Health
• Vijayakuman Varadarajan, University of South Wales
• Vikram Dhillon, Wayne State University
• Yuichi Ikeda, Kyoto University

The 2021 ConV2X Annual Symposium  featured a scientific program of academic/research presentations in addition to business and industry talks. The research track  focused on exploring and sharing developments in blockchain and emerging technologies in health and clinical medicine. Submissions were based on original research, conceptual frameworks, proposed applications, position papers, case studies, and real-world implementation. Selection was based on a peer-review process. Faculty, students, and industry researchers were encouraged to submit abstracts to present  ideas before an informed and knowledgeable audience of industry leaders, policy makers, funders, and researchers.

All presentations were reviewed by a sub-group of the scientific reveiw committee. This video presentation is an example of the discussions that transpired for each category of submissions, specifically, blockchain applications.

Submission Review Committee

• Dave Kochalko, CEO of ARTiFACTS
• Anjum Khurshid, UT Austin
• Carlos Caldas, UT Engineering
• Gil Alterovitz, Harvard Medical School
• Kayo Fujimoto, UT Health Houston
• Lei Zhang, University of Glasglow
• Sean Manion, CSciO of ConsenSys Health
• Vijayakuman Varadarajan, University of South Wales
• Vikram Dhillon, Wayne State University
• Yuichi Ikeda, Kyoto University

The annual ConV2X is a leading international health tech symposium driving real world evidence, strategy, research, operations and trends to create a blueprint for a new digital health era. The 2021 symposium featured a scientific program of academic/research presentations in addition to business and industry talks. The research track focused on exploring and sharing developments in blockchain and emerging technologies in health and clinical medicine. Submissions were based on original research, conceptual frameworks, proposed applications, position papers, case studies, and real-world implementation. Selection was based on a peer-review process. Faculty, students, and industry researchers were encouraged to submit abstracts to present ideas before an informed and knowledgeable audience of industry leaders, policy makers, funders, and researchers.

This presentation was selected by the scientific review committee.

Submission Review Committee

• Dave Kochalko, CEO of ARTiFACTS
• Anjum Khurshid, UT Austin
• Carlos Caldas, UT Engineering
• Gil Alterovitz, Harvard Medical School
• Kayo Fujimoto, UT Health Houston
• Lei Zhang, University of Glasglow
• Sean Manion, CSciO of ConsenSys Health
• Vijayakuman Varadarajan, University of South Wales
• Vikram Dhillon, Wayne State University
• Yuichi Ikeda, Kyoto University

Background: The current healthcare ecosystem in the United States is plagued by inefficiencies in transitions of patient care between healthcare providers due in large part to a lack of interoperability among the many electronic medical record (EMR) systems that exist today. Both providers and patients experience significant frustration due to the negative effects of increased costs, unnecessary administrative burden, and duplication of services that occur because of data fragmentation in the system. Blockchain technology provides a solution to mitigate or eliminate these gaps by allowing for healthcare information exchange that is distributed, auditable, immutable, and respectful of patient autonomy. Our multidisciplinary team identified key tasks required for a transition of care to design and develop a blockchain application, MediLinker, that served as a patient-centric identity management system to address the issues of data fragmentation ultimately allowing for the delivery of high value care.   Methods: The MediLinker application was evaluated for its ability to accomplish various key tasks needed for a successful transition of patient care in an outpatient setting. Our team created twenty unique patient use cases covering a diversity of medical needs and social circumstances that were played out by participants who were asked to perform various tasks as they received case across a simulated healthcare ecosystem composed of four clinics, a research institution, and other ancillary public services. Tasks included, but were not limited to, clinic enrollment, verification of identity, medication reconciliation, sharing insurance and billing information, and updating demographic information. With this iteration of MediLinker, we specifically focused on the functionality of Guardianship and patient revocation of healthcare information. Additionally, throughout the simulation we surveyed participant perceptions regarding the use of MediLinker and blockchain technology to better ascertain comfortability and usability of the application.   Results: Quantitative evaluation of simulation results revealed that MediLinker was able to successfully accomplish all seven clinical scenarios tested across the twenty patient use cases. MediLinker successfully achieved its goal of patient-centered interoperability as participants transitioned their simulated healthcare data, including COVID-19 vaccination status and current medications, across the four clinic sites and research institution. In addition to completing all key tasks designated, all eligible participants were able to enroll with and subsequently revoke data access with our simulated research site. A high degree of data accuracy was noted with most errors occurring due to inaccurate data entry from user input. Our qualitative analysis of user perceptions indicated that comfortability and trust with blockchain technology, such as MediLinker, grew with increased education and exposure to such technology.   Conclusion: The ubiquitous problem of data fragmentation in our current healthcare ecosystem has placed considerable strain on providers and patients alike. Blockchain applications for health identity management, such as MediLinker, provide a viable solution to stem the inefficiencies that exist today. The interoperability that MediLinker provided across our simulated healthcare system has the potential to improve transitions of care by sharing key aspects of healthcare information in a timely, secure, and patent-centric fashion allowing for the delivery of consistent personalized high-value care. Blockchain technologies appear to face similar challenges to widespread adoption as other novel interventions, namely recognition, trust, and usability. Further development and scaling are required for such technology to realize its full potential in the real-world and transform the practice of modern healthcare.