4. MedRec in the Context of National Healthcare Priorities
As mentioned in the introduction, we do not present MedRec as a panacea nor as the only
blockchain-mediated solution that would be needed to achieve our stated goals of data access, patient-
empowerment, interoperability and improved medical research. In the analysis below, we refer to MedRec
by name to suggest how such a project might address national healthcare priorities, likely as part of a
larger suite of blockchain solutions to which we hope to contribute.
Most importantly, the MedRec model restores comprehensive patient agency over healthcare
information—across providers and treatment sites, empowering citizens with the data they need to make
informed decisions around their care. By giving patients a long-term, trusted log of their information with
data sharing functionality built-in, the MedRec system directly addresses the ONC Interoperability
Roadmap’s first Outcome: “Individuals have access to longitudinal electronic health information, can
contribute to the information, and can direct it to any electronic location” [16]. As envisioned by the
Precision Medicine Initiative (PMI), the MedRec patient record would reflect the many facets of health
data, by accepting not just physician data, but also data from the patient’s Fitbit, Apple HealthKit,
23andMe profile, and more. Patients can build a holistic record of their medical data and authorize others
for viewership, such as physicians providing a second opinion or family members and care guardians.
MedRec data can also feed into emerging technologies for predictive analytics, allowing patients
to learn from their family histories, past care and conditions to better prepare for healthcare needs in the
future. By employing open APIs like MedRec, machine learning and data analysis layers could be added
to repositories of healthcare data to enable a true “learning health system” [16]. Due to the linked
interoperability between provider databases in a MedRec network, better-unified access to data could
facilitate a wide range of trend discovery. MedRec’s modularity could support an additional analytics
layer for disease surveillance and epidemiological monitoring, physician alerts if patients repeatedly fill
and abuse prescription access (e.g. part of the national problem with narcotics abuse [17]), personal
dashboards that show patients emerging trends in their own health, etc. In this respect, MedRec enables a
service-oriented architecture (SOA) as outlined in the ONC Roadmap’s “Secure, Standard Services” [16].
MedRec’s community model, where medical researchers (and potentially other regulated
stakeholders in the healthcare industry) can obtain insightful, population-wide data on medical treatment
offers an unprecedented opportunity to achieve goals for precision medicine and evidence-based research.
Such a system would facilitate the Patient-Centered Outcomes Research Institute’s goals for comparative
clinical effectiveness research [18], by linking the patients within a particular clinical cohort with both
granular and long-term medical history, thus enabling a better understanding of patient outcomes across
treatment groups and over time. By leveraging a data orchestration system like MedRec where the records
would already be gathered, organized and available for analysis, this type of research can be achieved with
significantly less overhead than traditional research trials, which often require expensive recruitment
procedures and in-person access to patients. This ability to carry out longitudinal studies on MedRec user
cohorts directly addresses both the ONC Interoperability Roadmap stated Outcomes [16] and the PMI’s
goal for a national research cohort [19].
The MedRec smart contract structure serves as one model for a “Health Care Directory and
Resource Location,” secured with public key cryptography and enabled with crucial properties of
provenance and data integrity. This blockchain directory model supports the ability to “grow and change
dramatically throughout its lifetime— adding new participants and changing organizational relationships”
through stateful updates to the smart contracts [16]. A blockchain log could provide clarity for