When i was a kid and first heard about computers, and was exposed to them with dad's first experiences with a Commodore C-64 and an IBM PC Convertible 5140, immediately the question was "Dad, what is this? What is it for?". And an all familiar answer came, one we haven't had to explain in a few decades now:
Dad: "it's a computer. It can help write papers, kind of like a typewriter, except i can make corrections before i print the paper, as many as i wish! And it can also calculations for me: like i can keep track of my finances."
Son: "What else can i do with it?"
Dad: "One day, computers will be everywhere and we will store all sort of information in them. We will be able to store our medical history in them. Medical charts. Imagine: a person will be able to go in a hospital, any hospital in the world, they'll just walk in, show their ID, and the staff will be able to access their entire medical history, since they were born. No more ambiguous notes or prescription, it will all be just one".
Son: "Wow. Why? How is it now?"...
Anyways, we've had this dream for a long time now. Computers have been able to make things come true, things we never even dreamed of before. Well, how about things we did dream of before? Some if it became reality, but what happened with this specific medical informatics dream? 30 years have past and it never turned into reality! How come? Certainly many people must have worked on it.
So, as it turns out, this dream is a tricky one. Seems pretty easy, right? Just have someone write some good database system which is scalable, very scalable and then have everyone use it.
Oh. Everyone?
Yep. Everyone. Otherwise it won't work. The dream of being able to walk into any medical institution anywhere and them having access to my medical records if i allow them, requires every single medical institution to use this very scalable database. Well, with the traditional client-server based network schema this doesn't seem too realist. Let's take a closer look
This is the scheme that has been around the longest. It's very simple: there's a central server which provides information or services to it's clients, which are the consumers of it's services. One can't really do much with the server alone, unless one has a client as well.
The problems associated with this scheme are
And then there are more problems and concerns which actually make this task quite hard, as addressed in Vest and Gamm’s paper titled “Health information exchange: persistent challenges and new strategies”, including:
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.As Ben Yuan, Wendy Lin, and Colin McDonnell state in "Blockchains and electronic health records", three factors are particularly important in health care:
In the paper, the authors explain how the blockchain can achieve all three of these requirements. However, the data interoperability discussed in the paper is a very low level interoperability, which doesn't take into consideration the application layer. In other words, surely every node on the medical network will have to speak the network's language. However, every node, whether a medical provider or a patient or a payor will be running a different software, which will be handling data at a high level, like "please download the patient's intraoral photographs taken in 2016". This means that the patient's intraoral photographs will have to be stored with appropriate meta data in an standard way, which is when it will be necessary to take a serious look at what kind of informatics medical standards exist.