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The data health interoperability is still a problem as of now in health professions and institutions. There has been a record of how to provide an open access to health data, the Blockchain technology, and Smart contracts have been an innovative way of keeping references to Electronic Health Records. This technology gives the patient the right to his or her health record and it also allows health professionals and institutions to access patients data owned by other institutions. The following helps to show how blockchain and smart contracts can be applied to improve EHR giving only the patients and health professionals or institutions permission to health data without the involvement of a third party without permission.
A situation in which a patient with a health issue has a chance in a physician in a separate health institution different from his or her regular health institute can cause several technical and nontechnical problems. In this situation, some questions arise such as: how to find and access the patient's data and also which privacy restrictions may be observed such as privacy of data, trust in health institutions, etc. may pose some challenges such as data format standardization. Data privacy and Data access ability are two contradicting and yet important concepts in healthcare organizations.
Most times, a patient requires visiting another physician from a different health institution and this institution should be able to access the patient's record. The institutional health record is not always open to other institutions and health records are not always interoperable. These issues are well known in medicine as care coordination. A situation in which the medical condition presented by the patients prevents him or her from granting permission to her health record, the "break the glass" mechanism is used. When a health institution is granted access to such records under certain conditions with a statement that the patient has explicitly declared to grant such permission under a specified condition.
Blockchain solution can enable large scale accessibility, keeping data privacy, reducing curating and meditating cost, and also providing trustless trust in the information system. Blockchain has been well distributed and coordinated based on its most popular technological usage in cryptocurrency such as Bitcoin, the blockchain has been proposed as a means to implement different kinds of decentralized applications. The blockchain technology is grounded on the notion of a distributed ledger which behaves like a database that contains information about the history of transactions involving agents.
This information is audited by a group of agents and the result is stored in a block and broadcasted to the network. The blocks are sequentially appended to the ledger forming a cryptographically linked chain. Attempts to tamper with the ledger can be easily detected. The reliability of a blockchain can be accepted or rejected. If the agents receive several valid additions to their local copy of ledger, they always choose the longest chain of valid blocks ignoring other conflicting and less relevant chains. Insertion of malicious entities on the ledger will be rejected by the community and ignoring their chain forcing them to abide by the rules. If auditing is accepted, then the ledger is replicated across the agents. If otherwise, the largest accepted portion of the ledger is replicated with information about dissonances and corresponding actions to be taken.
The blockchain can allow the accessibility of various institutions to health data provided that solutions are given for latency and storage requirements related to it given peers are required to store copies of ledger and transactions. The blockchain, per se, are disseminated across the networks of peers. The smart contract, on the other hand, can be used to implement agents that are relevant to manage information. It can also contain rules to discipline access to the content of encrypted health information.
In recent years, only a few studies discussed the real implementation of EHRs over blockchain since it is a relatively new technological development. Blockchain and smart contracts can help in meeting the requirements of the following for an open a global EHR system: Data accessibility and management affected by the cost of acquiring mediators and Trust must be established by stakeholders for information keeping. Blockchain has provided an alternative of having a decentralized network of mediators to store and manage information. Also, Privacy levels and anonymization; the smart contracts helps to keep data safe and secure with defined sets of rules for each subsection. Blockchain can also help to provide the "break the glass" mechanism.
Another thing is the Ethical issues which could be an ethics of data, algorithms, practices, and these ethical issues can be controlled by a set of related dilemmas. The general architecture for a global scale EHR based in blockchain involves transactions through blockchain, wallets, data services and discovery units in which it delegates the data management to the users. The patient has full control over his or her data. When this system is put to use, the blockchain stored the history of interaction between patients and health care agents, together with the links to EHRs that contain detailed descriptions.
The ledger component can be implemented using the Ethereum platform and its smart contracts solution. The wallet can also have a mobile version and the Cloud services can be implemented for data storage. The integration of Gevwallet and data repository can be implemented through the Google App Script (GAS). The proof of work in blockchain refers to the indication of new transactions and also the adoption rate of the system.