Blockchain Based Electronic Health Record Management For Mass Crisis Scenarios : A Feasibility Study

Abstract: Electronic Health Records (EHRs) are both crucial and sensitive as they contain essential information and are frequently shared among different parties including hospitals, pharmacies or private clinics. This information must remain correct, up to date, private, and accessible only to the authorized people. Moreover, the access must also be assured under special conditions mass crises like hurricanes or earthquakes where disruption, decentralized responses, and chaos could potentially lead to wrong procedures or even malicious behaviors. The introduction of blockchain a distributed ledger where the records are stored in a linked sequence of blocks and are theoretically difficult to delete or tamper with made possible to design and implement new solutions for more failure-resistant EHRs applications adopting a distributed and decentralized philosophy, in contrast with the central ones based on cloud infrastructures or even local solutions. In this context, this work provides a systematic study to understand whether permissioned blockchain implementations could be of any benefit to managing health records in emergency situations caused by natural disasters. After the design and implementation of a basic prototype for an EHRs management system in Hyperledger Fabric and the execution of a set of test cases based on the simulation of the Haiti earthquake of 2010, it was possible to discuss the benefits and tradeoffs that the system entails. The discussion focused on the performance parameters like throughput, latency, memory and CPU usage. The system allowed the patients and practitioners to share and access EHRs and be able to detect and react to the crisis situations. Moreover, it behaved correctly in the presence of malicious nodes assuring throughputs and latencies still lower, compared to current centralized systems like credit card payments, but already up to two orders of magnitude higher than permissionless blockchain implementations. Even though there is still a lot of work to do, the system represented by the prototype could be an interesting alternative for networks of healthcare companies to help ensuring the continuity of treatment while preserving privacy and confidentiality in extreme situations.