Human Factors in System Design

Running head: HUMAN FACTORS IN SYSTEM DESIGN
HUMAN FACTORS IN SYSTEM DESIGN
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1HUMAN FACTORS IN SYSTEM DESIGN
Executive Summary
A long-standing focus on compliance has traditionally constrained development of fundamental
design changes for Electronic Health Records (EHRs). We now face a critical need for such
innovation, as personalization and data science prompt patients to engage in the details of their
healthcare and restore agency over their medical data. In this paper, we propose MedRec: a
novel, decentralized record management system to handle EHRs, using blockchain technology.
Our system gives patients a comprehensive, immutable log and easy access to their medical
information across providers and treatment sites. Leveraging unique blockchain properties,
MedRec manages authentication, confidentiality, accountability and data sharing—crucial
considerations when handling sensitive information. A modular design integrates with providers'
existing, local data storage solutions, facilitating interoperability and making our system
convenient and adaptable. We incentivize medical stakeholders (researchers, public health
authorities, etc.) to participate in the network as blockchain “miners”. This provides them with
access to aggregate, anonymized data as mining rewards, in return for sustaining and securing
the network via Proof of Work. MedRec thus enables the emergence of data economics,
supplying big data to empower researchers while engaging patients and providers in the choice to
release metadata. The purpose of this paper is to expose, in preparation for field tests, a working
prototype through which we analyze and discuss our approach and the potential for blockchain in
health IT and research.

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Table of Contents
Introduction......................................................................................................................................3
Discussion:.......................................................................................................................................4
What is Blockchain? How it works?...........................................................................................5
Use cases or components of the system.......................................................................................6
1. Registrar contract (RC).................................................................................................6
2. Patient Provider Relationship contract (PPR)...............................................................7
3. Summary contract (SC).................................................................................................8
4. System node description................................................................................................9
5. Backend API library......................................................................................................9
6. Ethereum client............................................................................................................10
7. Database keeper...........................................................................................................10
8. EHR Manager..............................................................................................................11
9. MedRec blockchain mining.........................................................................................11
Usability requirements...............................................................................................................11
Evaluation of the software (Methods and Procedure)...............................................................13
Conclusion and Findings...............................................................................................................15
References:....................................................................................................................................17

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4HUMAN FACTORS IN SYSTEM DESIGN
Introduction
Today’s e-hospital management environment requires that interactive systems exhibit abilities
such as autonomy, adaptive and collaborative behavior, and inferential capability. Such abilities
are based on the knowledge about users and their tasks to be performed. To adapt users’ input
and tasks an interactive system must be able to establish a set of assumptions about users’
profiles and task characteristics, which is often referred as user models. However, to develop a
user model an interactive system needs to analyze users’ input and recognize the tasks and the
ultimate goals users trying to achieve, which may involve a great deal of uncertainties.
The interactive system chosen in this report is the use of blockchain in healthcare used for
accessing data in electronic health records (EHR) and medical research. The data is easily
available to patients and is high protected and securely kept via the blockchain security
measures. EHRs were never designed to manage multi-institutional, life time medical records.
Patients leave data scattered across various organizations as life events take them away from one
provider's data silo and into another. In doing so they lose easy access to past data, as the
provider, not the patient, generally retains primary stewardship (either through explicit legal
means in over 21 states, or through default arrangements in the process of providing care).
Through the HIPAA Privacy Rule, providers can take up to 60 days to respond (not necessarily
to comply) to a request for updating or removing a record that was erroneously added. Beyond
the time delay, record maintenance can prove quite challenging to initiate as patients are rarely
encouraged and seldom enabled to review their full record. Patients thus interact with records in
a fractured manner that reflects the nature of how these records are managed.

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Our blockchain implementation addresses the four major issues highlighted above: fragmented,
slow access to medical data; system interoperability; patient agency; improved data quality and
quantity for medical research. We build on the work of Zyskind et al. to assemble references to
data and encode these as hashed pointers onto a blockchain ledger. We then organize these
references to explicitly create an accessible bread crumb trail for medical history, without storing
raw medical data on the blockchain. Our system supplements these pointers with on-chain
permissioning and data integrity logic, empowering individuals with record authenticity,
auditability and data sharing. We build robust, modular APIs to integrate with existing provider
databases for interoperability. A novel data-mining scheme is proposed to sustain the MedRec
network and bring open, big data to medical researchers. We present MedRec not as the panacea
for medical record management, but as a foray into this space to demonstrate innovative EHR
solutions with blockchain technology.
Discussion:
For MedRec, the block content represents data ownership and viewership permissions shared by
members of a private, peer-to-peer network. Blockchain technology supports the use of “smart
contracts,” which allow us to automate and track certain state transitions (such as a change in
viewership rights, or the birth of a new record in the system). Via smart contracts on an
Ethereum blockchain, we log patient-provider relationships that associate a medical record with
viewing permissions and data retrieval instructions (essentially data pointers) for execution on
external databases. We include on the blockchain a cryptographic hash of the record to ensure
against tampering, thus guaranteeing data integrity. Providers can add a new record associated
with a particular patient, and patients can authorize sharing of records between providers. In both
cases, the party receiving new information receives an automated notification and can verify the