Estonia has long proclaimed itself as the first country to fully embrace blockchain technology, and its use of the technology in healthcare presents a compelling role model for other national authorities to consider. This is one of the thousand digital services that Estonia provides in its e-Estonia program.This is first and foremost a security solution, protecting the authenticity of electronic health records, and managing access to the records, while keeping patient data and personally identifiable information (PII) off the blockchain.
This solution incorporates a vendor-proprietary ledger that is built for scale while claiming to require significantly less storage space and faster transaction times than Bitcoin’s distributed ledger. The foundation for this system is Guardtime Federal’s Keyless Signature Infrastructure (KSI) technology which leverages Merkle trees to connect artifacts (hashes) of each data entry. The only data that is widely distributed and publicly revealed is a hash which can be used by parties seeking to verify the authenticity of health record elements, stored in Oracle databases, without exposing patient data.
Guardtime’s KSI Technology white paper states: “this deployment of KSI in X-Roads, e-Estonia and the Estonian health care system enables individuals, their families and health care providers access to electronic health information in a secure, timely and reliable manner to support the health and wellness of individuals through informed, shared decision-making. Individuals and caregivers are enabled to participate in their health and care.”
Data security is a huge priority for Estonia with 95% of health data digitized and 97% of patients holding a countrywide digital record – Guardtime’s solution provides an added layer of assurance. Though this implementation doesn’t rely on the Bitcoin or Ethereum platforms, Guardtime’s technology realizes security benefits of blockchain by cryptographically linking “data assets with immutable properties.” As far as security goes, the task seems to be in good hands as the company’s founders were working on “new security property of hash functions” before Bitcoin came into existence.
While this is the most advanced application of blockchain technology for electronic health records, it does not take full advantage of the decentralization benefit typical of Bitcoin and Ethereum environments which adds significant protection to the data stored on the blockchain.
- Guardtime Federal white paper on Keyless Signature Infrastructure (KSI)
- Guardtime’s blog article describing the work with Estonia’s e-health authority
- Healthcare page on Estonia’s e-Estonia website
- Research Paper by Guardtime founders Ahto Buldas and Märt Saarepera: “On Provably Secure Time-Stamping Schemes”