The COVID-19 global pandemic is stressing the worldwide healthcare system, and the speed of the epidemic spread is taking unprecedented resources from states and governments. Existing government and healthcare data infrastructure is neither adequate nor ready to cope with today’s situation, where the information sharing for multiple patients and coordination of trusted data — at lightning speed — are essential to stop the viral propagation to other segments of the population. Emerging blockchain distributed ledger technology solutions (DLT), combined with fast COVID-19 cloud-based testing procedures and patient onboarding with real-time monitoring solutions, are key to integrating and creating a COVID-19 digital healthcare system. An end-to-end COVID-19 patient management system can use digital technologies to identify, isolate, and manage patients, alleviating the overloading of hospitals and stress on resources.
The Challenges in Combating COVID-19
The fundamental challenges in combating COVID-19 can be summarized in the following three steps:
Speed up COVID-19 patient sample data testing collection, analysis, and diagnosis. Symptomatic patients should have health checks and test data collection for COVID-19 at distributed health check points, or point-of-care (POC). All tests and results shall be stored on a distributed data cloud and made available to healthcare authorities in semi-real time (less than 10-15 minutes) to be effective; quickly identifying positive COVID-19 patients for further actions.
Registration of COVID-19 patient data in a healthcare government database. Once test results are confirmed positive and patients have received test confirmation, all data should be automatically registered in a distributed government database. The access to this database should be shared across other databases, giving visibility to other health and law enforcement agencies and authorities to monitor and manage COVID-19 patients, while preserving patients’ data privacy.
Monitoring and controlling COVID-19 patient quarantine and their health conditions. After all patients are registered and on-boarded onto a government database, their health conditions and quarantine status should be actively monitored. Eventually, all of this information should also be communicated and shared across law enforcement agencies to guarantee that quarantine is occurring and is not being violated.
Figure 1 illustrates these three steps. Step 1 considers the use of Internet of Things (IoT) COVID-19 test devices, connected to the Internet, for immediate sharing of the results to a public or private cloud database. In Step 2, the confirmed COVID-19 patients are registered and on-boarded onto a government database. And in Step 3, a geo-referenced mobile system can be used for real-time patient monitoring and healthcare management. All these steps consider a private-proof solution with the best technologies to isolate and monitor the patient.
Without these actions, the coronavirus may spread from 5, 50, 500, to 5,000 very quickly. Sharing patient data information at lightning speed among authorities, who can take strong and quick measures to contain the virus epidemic propagation, are vital steps.
Existing COVID-19 Healthcare’s Broken Data Lake Silos
The three challenges specified above are not currently met using existing data lake architectures and public and private cloud database infrastructure, since most of them are centralized silos — neither coordinated and shared, nor synchronized across other parties.
Centralized databases act like data lake silos, where coordination among multiple authority databases takes time to collect, process results, identify, and isolate COVID-19 patients. If the test data takes time to process the results; if COVID-positive patient data sharing among several government agencies and hospital databases takes time; and if actions to isolate and control the patient are not well coordinated and managed with a cohesive end-to-end healthcare data infrastructure, the spread of the coronavirus will be compromised.
Sharing the evolution of COVID-19 cases and patient information in near real time is essential to combat and control the spread of the epidemic. However, existing government database solutions (POC, clinical labs, drive-through testing points, medical clinics, pharmacies, hospitals and other government agencies) are currently broken data silos, with delays in sharing important and trusted patient information across multiple entities to fight COVID-19. Figure 2 shows the limitations of current siloed healthcare database solutions to effectively handle COVID-19 patient monitoring and control.
Using Blockchain to Speed Patient Information Data Sharing
Blockchain digital transformation technology is decentralized, secure, and scalable, and can meet the challenges of existing siloed cloud-based data infrastructure shown in Figure 2. Blockchain is based on DLT, where the data is hashed, encrypted, and shared among authorized participants (e.g., healthcare agencies and authorities).
Permissioned enterprise-grade blockchain is ideal for a COVID-19 authority, government-based management solution. Only authorized participants can have access to patient records, using secure encrypted keys that unlock certain metadata information. Each main authority or healthcare participant can host a distributed ledger in their cloud data to keep track and help with the blockchain consensus algorithm to validate and authenticate all blockchain data transactions with transparency and immutability.
Trusted, distributed, and secure COVID-19 patient data and transactions can be shared across multiple government participants and interested parties in almost real time. This unique solution would create the first COVID-19 county, city, state, or country-based digital healthcare infrastructure to manage and integrate dispersed and siloed COVID-19 databases.
Blockchain-Enabled COVID-19 Healthcare Infrastructure
A real-time, seamless, multiparty coordination among healthcare participants and authorities is the ideal digital infrastructure for an end-to-end COVID-19 patient management solution. Blockchain DLT is the only enabling layer available today that can make it happen and be implemented in a short time period, connecting to existing off-chain government databases to log, register, monitor, and track registered COVID-19 patients with visibility and immutability of data records. Figure 3 shows a multiparticipant (healthcare and other government authorities) coordination, data privacy–proof, blockchain-enabled COVID-19 healthcare infrastructure.
Challenges of Shared Database to Fight COVID-19 and Compliance with Patients’ Data Privacy
The steps and architecture shown in Figure 3 must address the COVID-19 patients’ personally identifiable information (PII) data privacy rights. Despite the importance of sharing patients’ data with multiple authorized participant authorities to improve the flow of patients’ data for monitoring and control, this must be designed and accomplished using industry’s best practices. This patient data, particularly the geo-referenced, real-time mobile data, can be stripped of identifying information and can be used only for selective quarantine mandates of confirmed COVID-19 cases.
In spite of privacy rights limitations, governments and mobile operators can still use existing location-based applications to monitor patients and large groups of people, just as a standalone technology option that doesn’t have a cohesive end-to-end COVID-19 patient management solution (see Figure 3). If well-designed, the privacy-proof blockchain DLT solution, combined with other available technologies, can address these challenges to preserve the data privacy compliance of COVID-19 patients' PII and their metadata.
COVID-19 is spreading at fast speed, and time is of the essence to share, coordinate, and take actions to mitigate pandemic propagation. Current centralized database solutions solve part of the problem, but require an overarching and time-consuming coordination between multiple government and health authorities, including the entire chain of decision makers to collect test data, analyze/diagnostic, register, monitor, and enforce regulations and policies to isolate and monitor COVID-19 cases. Blockchain DLT technology, combined with cloud databases and mobile geo-fencing technology, solves the coordination challenges of broken healthcare centralized data lake silos, creating an open, trusted, immutable, and decentralized data architecture framework to speed up a multi-party, end-to-end COVID-19 data-sharing and patient monitoring coordination process, while preserving patients’ data privacy.