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This section of the site lists the proposed architecture of MedRec 2. This is intended to be a working document, and will grow as the new codebase develops. This implementation forms an architectural basis for MedRec 2. In particular, MedRec 2.
Since the original chain was forked from Ethereum, the official client has changed to a point where the MedRec app could not be returned to the public blockchain as was originally intended , and the code has become obsolete. A discussion of public, private and consortium models for blockchain management is explored later on. MedRec is built on the Ethereum blockchain, released by founder by Vitalik Buterin in This significantly broadens the scope of the Bitcoin blockchain from a purely transactional set of operations to a Turing-complete language that supports diverse applications.
Ethereum consists of a system of nodes personal computers, clusters, virtual machines in a decentralised network which.. Smart contracts are not a replacement for contracts in the traditional sense, rather they are agreements to execute some action or code given a set of conditions.
In the case of MedRec, these contracts can be used to encode a set of pointers to the locations of medical data. Medrec does not store EHRs directly on the Ethereum blockchain, instead using a relational set of smart contracts to encode pointers, which may be used to locate and authenticate to record locations. MedRec defines three main kinds of smart contract, within which there is some variation between contracts belonging to patients, providers and other forms of user.
The registrar contract maps participant IDs patients, providers, insurers to their Ethereum address identity equivalent to a public key. The regulation of new identities can be encoded into the contract, ensuring that only certified institutions may add new information onto the blockchain. In turn, new information concerning a patient e. Each identity string is located at an address on the blockchain, where it is referenced by a Summary Contract.
This raises some questions about the suitability of a global system of IDs, which is addressed later on in a discussion of privacy. The patient provider relationship contract links two nodes in the system, where one node stores and manages medical records for the other.
This relationship could exist between a particular care provider and patient, but extends to cover any pairwise data stewardship interaction. The summary contract serves as a trail of bread-crumbs, where each participant in the system can locate a summary of their relationships with each other participant. The summary contract encodes a list of references to Patient-Provider Relationship contracts, giving both current and previous engagements with other nodes on the system.
The acceptation, rejection or deletion of relationships is controlled by the patient, giving full control over which records in their history they wish to acknowledge. This feature of MedRec is key to satisfying its usability criterion: A diagram showing the possible relationships between different patient and provider contracts is shown below.
Note also that the contracts are only used to provide pointers: The Gatekeeper runs a server listening to query requests, which are cryptographically signed by the issuer, from clients on the network. The cryptographic signature allows the gatekeeper to confirm identities, and then check the blockchain contracts to verify if the address issuing the request is allowed access to the query. MedRec also defines a modular interoperability protocol, which can interface with any provider backend and UI implementation.
MedRec does not seek to build directly on the public Ethereum blockchain, instead constructing a private peer-to-peer network of trusted, verified nodes. It is this private client that defines a Global Registrar a contract mapping all public identities to Ethereum addresses , ensuring that only registered healthcare providers are permitted to append blocks to the MedRec blockchain. If a private blockchain is used, we may also use a different consensus mechanism to the main Ethereum blockchain.
Here we only allow verified sealers to vote on appended blocks, rather than the Proof-of-Work algorithm, which requires the computation of hashes to contribute to the maintenance of a distributed ledger. Mining mechanisms to sustain the distributed ledger would still be required: Another suggestion, made by MedRec 1. Blockchain technologies introduce a number of privacy limitations, some of which are mitigated by the use of a permissioned read access structure and private blockchain.
A key issue is that, even without the direct disclosure of a patient name, inference about who a particular patient is could be drawn from metadata of one ethereum address with multiple others. Even with a private blockchain, we must consider mining nodes, who process this sensitive metadata. One solution is to require all miners to be fully-permissioned, and require medical researchers running mining nodes only to do so on secured systems.
One future goal of the project is to perform a full k-anonymity analysis of the query structure to ensure that privacy is preserved. In addition, MedRec proposes the addition of encryption in the off- blockchain synchronisation steps, safeguarding against accidental or malicious content access. In order for the relationship to be created securely, however, the provider could not append the fresh block containing this new address itself as it would be simple to trace back each of these delegate addresses to the original.
Thus, on creating a new delegate account, the provider performs an off-blockchain transaction with another verified provider at random, giving them the details of the new delegate account, which they may append as a verified account to the blockchain. The decentralised nature of blockchain-based systems gives MedRec the advantage of robustness both in the maintenance of authorisation data which is maintained in every node in the network , and in the storage of records themselves which are persisted in both patient and relevant provider nodes.
As many entities participate in the system, consensus mechanisms also mean that single points of failure are avoided. As the medical data and the global authorisation log are distributed, there is no central target for attack or failure, and the network is robust to tampering as an altered node would be in conflict with the other, unaltered nodes and would not pass a consensus. MedRec also assumes that nodes are bound by external regulation governing data copying, and does not seek to address this in its own right.
Scalability is an ongoing concern in the Ethereum community and one that has yet to be fully resolved. One of the key issues is that any event stored at any time on the blockchain will appear in every subsequent block. Though this is also a property of the Bitcoin blockchain, as Ethereum provides the potential for both data storage and more complex operations, the repercussions of this growth are more of an issue. One advantage of a private blockchain is that the app only needs to track back to the genesis of the private chain, not Ethereum as a whole.
However, MedRec must still address its own scaling. A key architectural modification between MedRec 1. This change also means that the pseudonymity issue associated with communication between patients and providers is somewhat mitigated. Looking at the blockchain, an external observer might view a relationship between patient A and provider X, but would not be able to determine the frequency by which the 2 communicated, as that interaction.
About Team Signup Technical Documentation. Smart Contract Structure Medrec does not store EHRs directly on the Ethereum blockchain, instead using a relational set of smart contracts to encode pointers, which may be used to locate and authenticate to record locations. Registrar Contract The registrar contract maps participant IDs patients, providers, insurers to their Ethereum address identity equivalent to a public key.
Patient-Provider Relationship Contract The patient provider relationship contract links two nodes in the system, where one node stores and manages medical records for the other. Summary Contract The summary contract serves as a trail of bread-crumbs, where each participant in the system can locate a summary of their relationships with each other participant. Privacy Blockchain technologies introduce a number of privacy limitations, some of which are mitigated by the use of a permissioned read access structure and private blockchain.
Security The decentralised nature of blockchain-based systems gives MedRec the advantage of robustness both in the maintenance of authorisation data which is maintained in every node in the network , and in the storage of records themselves which are persisted in both patient and relevant provider nodes.
Scalability Scalability is an ongoing concern in the Ethereum community and one that has yet to be fully resolved. The alternative approach changed between MedRec 1.