There are so many privacy breaches in medical data, hacked accounts,
data-leaks, wacky account rules, social hacking, temporary personal from
employment agencies, no logging on access to systems, systems standing
open and the nurse doing something else.
A GP can call a specialist, it is very common to call a specialist, and
say that information is needed on patient So and So. This happens so
many times. He does not need to prove that he is the GP for that
patient. A specialist does not have time for that kind of verifications.
And when you talk about these kind of things to clinicians, the all
denying, but they all know better.
And when you talk about these kind of things to software companies, they
start denying too, their software is oke!
But it isn't, because a doctor does not pay for security, but for nifty
software. On security no money can be earned.
So unless you are talking about the openEHR system being actively
hacked, I don't think this is a real use case. If we are talking about
the openEHR versioning being hacked, then a) they had to hack RAID 10
storage, DB persistence mirroring, daily backups, b) the data centre
has singificant security, c) some security analysis will have been
made in advance (it will, won't it?!), and depending on the perceived
threat, there may be e.g. hashing + notary, or signed hashes + notary,
which requires the hackers to be of a superior variety.
No one ever hacks a RAID-system, they hack the software. The RAID system
is to the software like a single disk, if you remove data from software,
then the RAID system will remove it too, it follows the software. The DB
persistence mirroring is the same story. Daily backups are never rolled
back (only in disaster scenario), because you will lose all newly
entered data.
A friend, a journalist was taking track of all illegal data-leaks in
medical context, he has done that for over ten years.
It must have been millions of patients whose data are leaked, stolen
notebooks with copies of databases, lost USB-sticks, hacked accounts,
every day there is something. It happens in the best secured
organizations like the army. A container full with
paper-patient-dossiers was standing on the street in a big city.
Harddisks are not always cleaned up when sold to second hand
computer-shops. I once got (so was said) a brand new server-hard-disk
from HP-reseller, it wasn't new, there were data on it.
Mostly this news is from the USA because there they is the obligation to
report data leaks to the public. In the Netherlands this is not so, and
guess who is against such a law?
https://www.google.nl/search?q=data+leak&source=lnms&tbm=nws
It's a fair bit of work to invisibly hack a properly implemented
versioned DB implementation within a secure facility, which is what is
needed for a medico-legal claim based on data to fail.
How about a patient who discovers its employer has knowledge of
private medical data? People often think about psychiatric
circumstances, but it can be other things in this time of revival of
religions, f.e. a woman who hides the fact she has had an abortion
and is now teaching on a christian school.
ok, now that's privacy, so we are talking data theft, not integrity or
non-repudiation of authorship.
Yes, that is, and maybe it is just paranoia, everybody has the right to
be paranoid. Special in small communities data can leak very easy.
Social hacking, you can call that. Happens all the time. But that kind
of leaking cannot always be avoided with blockchain, unless the leaking
GP is looking at someone else his system over a secured logging
communication-network. Then it should be that the looking into data will
be in a transaction, because it is interchanging medical data, which
must guaranteed to be complete, unaltered and logged at receiver and sender.
Also interesting in this discussion is how to handle deletion of
medical data (the patients right to be forgotten).
Can it be that data refer to data on other systems, or may they only
refer to data on the same system, copies of data from other systems?
Do these copies need some accountable reference to where they come from?
these are I agree, important questions, and we've tried to cover some
of it with openEHR e.g. via FEEDER_AUDIT
<http://www.openehr.org/releases/RM/latest/docs/common/common.html#_feeder_system_audit>,
URI datatype, and more recently some thinking in a new REPORT type
<https://openehr.atlassian.net/wiki/spaces/spec/pages/92358988/Reports>
being considered for the RM (I've added a note to this to cover the
requirement to safely refer to / ?copy content from external systems).
We need to consider these kind of reference questions more carefully
and provide more comprehensive solutions for sure.
It is a very complicated subject, and I did not expect any action taken
on my initial question, yesterday morning. But there was discussion, I
also learned from it.
Huge ICT companies are implementing blockchain-applications, and the
medical world will for sure be one of the targets. They are ready to
implement and sell it. They will convince governments that it is needed.
In the Netherlands, Nictiz is on their side. Nictiz is the only
information-source for the government.
My question is, can this be transparent, (like RAID 10 is to a system),
or is there an architectural change needed on the logical layers? Or is
there an architectural layer desirable? Do medical software architects
want to influence decisions? Then they need to take positions.
It is not something for today or tomorrow, or the day after tomorrow.
But next year? In two years?
IBM is selling blockchain-technology:
https://www.ibm.com/blockchain/nl-nl/get-started/
Today I was reading about Mastercard going to use blockchain, they
patented an own implementation (sorry, in Dutch)
https://www.agconnect.nl/artikel/mastercard-legt-eigen-blockchain-vast
The patent
http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=/netahtml/PTO/search-adv.html&r=1&p=1&f=G&l=50&d=PG01&S1=20170323294.PGNR.&OS=dn/20170323294&RS=DN/20170323294
Best regards
Bert
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