Patients As Peers: Blockchain Based Ehr And Medical Information Commons Models For Hitech Act Compliance

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Nova Law Review


Touted as a revolution in patient health care, existing electronic health records ("EHR") systems have failed to meet Congressional and private aspirations for improving patient outcomes and recognizing operational cost savings.' A combination of technological shortcomings and anticompetitive incentives to engage in information blocking has resulted in a systemic failure of both health care providers and patients to reap the promised beneficial yields of adopting comprehensive EHR systems. In this Article, we explore how utilization of distributed ledger technologies, such as blockchain ledgers, can better promote interested stakeholder's interests in adoption of comprehensive EHR systems, as blockchain ledgers improve patient outcomes, increase interoperability between health care providers, generate cost operational savings to health care, and simplify compliance with the Health Insurance Portability and Accountability Act ("HIPAA") privacy rule.' In Part II of this Article, we address existing EHR systems. In Section II.A., we develop a working technological framework of EHR. In Section II.B., we explain Congressional efforts to promote comprehensive EHR adoption through the Health Information Technology for Economic and Clinical Health Act ("HITECH Act") incentives program. In Section II.C., we summarize the HITECH Act amendments to HIPAA Privacy Rule as they relate to the implementation of comprehensive EHR systems. In Section II.D., we review the empirical literature, which demonstrates how the adoption of existing EHR systems has led to marginal gains in patient outcomes and generated significant operational costs to health care providers. In Part III, we argue that blockchain ledgers, a nascent technological system can remedy the technological and social failings of existing EHR systems. In Part IV, we explore a number of blockchain-based EHR use cases supporting our arguments in Part III.

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Publication Date

Spring 2020