BitMED’s growth has not been without administrative and technical challenges. BitMED needed to address the privacy, security, and health care laws world-wide. We also knew the standard scaling patterns would not be sufficient to address the future needs of the ecosystem without serious rewrites at the expense of lower innovation in years 3-5; precisely the time we would need to jump to the next S curve. To address these and many other challenges, we prototyped and studied how to use blockchain smart contracts to speed up the rate of innovation while incentivizing all stakeholders in the ecosystem. We have determined that adopting and developing blockchain and smart contracts are the solution to the chicken-and-egg problem faced by online communities before network effects.
The BitMED Blockchain seeks to combine the best from blockchain technology and learning from existing health IT
What is the blockchain and why we decide to use it? Blockchain technology is a distributed ledger in which different computers – called nodes – cooperate as a system to store sequences of bits that are encrypted as a single unit or block and then chained together (hence the name Blockchain). The initial and now ubiquitous application of the Blockchain technology is Bitcoin, a form of digital cryptocurrency. The origins of Bitcoin are shadowy. It was first proposed in a 2008 posting attributed to Satoshi Nakamoto.
The name turned out to be a pseudonym, and no one has yet been able to uncover its real inventor. Technology underlying Bitcoin (i.e. Blockchain) is increasingly seen as a solution to myriad problems where there is a need for a trustworthy public ledger, such as ledgers of financial transactions (as in Bitcoin), land registries, civil registration and other types of public registration systems, especially in combination with “smart contracts” which automate the rules associated with certain types of contractual transactions (e.g. property purchases).
Transaction Manager - allows access to encrypted transaction data for private transactions, manages local data store and communication with other Transaction Managers.
Crypto Enclave - responsible for private key management and encryption and decryption of private transaction data.
Quorum Chain - voting-based, BFT-hardened consensus mechanisms that utilises core Ethereum features to verify and propagate votes through the network.
Network Manager - controls access to the network, enabling a permissioned network to be created.
Privacy Manager - enforces governance, compliance, modeling and risk to PII.
Clinical Manager - workflows, Clinical observations, clinical treatment, care provision, and medications.
Specialized Manager - allows for clinical decisions supports, artificial intelligence, and reporting agents.
Financial Manager - access and authorization for claims, benefits, and payments.
The BitMED blockchain is based on Hyperledger and Quorum technology which addresses the challenges of a permissionless ledger while supporting both transaction-level privacy and network-wide transparency, customizable to business requirements
- Smart contracts written for an existing Ethereum implementation remain network-transparent on BXM out of the box.
- Enhancing many existing smart contract designs to meet privacy requirements is simple and straightforward.
- All public and private smart contracts and overall system state derived from a single, shared, complete blockchain of transactions validated by every node in the global network.
- Private smart contract state is known to and validated by only parties to the contract and approved third parties, like regulators.
By having a permissioned distributed ledger of up to 200 trusted nodes, it allows us to lower the transaction cost, maintain thousands of transactions per second, comply with PII standards governing confidentiality, integrity and availability, and provide a path forward for existing health standards and protocols.