We are inspired by patients that require life sustaining medication, especially children that have undergone solid organ transplantation. Preventing a patient’s body from rejecting the transplanted heart requires medications that are given at the same time every day to maintain proper levels of the medication in the blood stream. Our passion for prolonging the life of transplanted organs drove us to look for tools to enhance medication compliance by improving the way prescription drug information is transferred and shared.
Scenario: A patient has either lost their anti-rejection medication or have run out it and they need to get a prescription filled urgently. The patient calls the transplant team at 7PM on a Friday or Saturday night asking for a new prescription so they don’t miss a dose. The patient might be out of town, their usual pharmacy may be closed, or their pharmacy may have run out of the medication.
The problem we run into is the need to specify a single pharmacy when we write our prescriptions. Multiple phone calls between the doctor, patient, and potential pharmacies are needed to make sure a patient is connected with a pharmacy with the required medication. If we cannot connect a patient to a pharmacy that has the medication, the patient needs to go to an emergency room that can dispense the medication.
There has to be a better way and the blockchain provides a potential solution. The blockchain provides the opportunity to send an electronic prescription to all participating pharmacies simultaneously. Private keys ensure that patient data are only seen by the patient, physician and pharmacy involved in the transaction.
- In summary, the problems a blockchain based prescription service could solve include:
- Lack of flexibility for pharmacy designation. The current electronic prescription services require the physician to designate one pharmacy to which a prescription is sent. This creates inefficiencies for the patient, pharmacy, and physician if the pharmacy does not have a certain drug and a new prescription has to be sent elsewhere.
- Inability for care teams to confirm the receipt of medications by the patient. The current electronic prescription data transfer process does not allow for physicians to know if the patient filled their prescription.
- Tracking prescriptions of controlled susbtances. Blockchain technology can help ensure that all prescriptions for controlled substances are properly tracked by regulatory agencies and that the proper individuals are obtaining the medications. Prescribers that are abusing the system for profit could be easily identified. Controlled substances require 2FA for electronic prescription and 2FA could be integrated into the application using the system currently utilized by a prescriber’s health information system (DUO, Google authenticate, etc).
What it does:
EthRx uses the blockchain to connect electronic prescriptions written by doctors to pharmacies via the blockchain. An electronic prescription on the blockchain is visible to all participating pharmacy systems while only allowing the prescribing pharmacy to see protected health information (PHI). The preferred pharmacy can be selected at the time the prescription is written by the physician or could be selected by the patient via the web, mobile application, or phone call with the pharmacy. Once the PHI is “unlocked, the designated pharmacy would then be alerted to prepare the medication. Changing the pharmacy would not require the prescription to be re-written. Instead, the patient would only need to change the pharmacy selection via the web, mobile application, or phone.
Once the electronic is picked up by the patient, the pharmacy updates its software. The blockchain is updated to show that the patient received the medication. The blockchain would then update the medical record to show the prescriber that the patient picked up the medication. This step is extremely valuable. Patients that are not taking their medication could be more easily identified and contacted, potentially preventing ongoing medication non-compliance. This improved compliance can save significant amounts of money by decreasing hospitalizations and severity of illness. Additionally, this transfer of data could be applied to databases of controlled substances to track both prescribing and use of controlled substances.
EthRx is also applicable to the most basic problems in primary care. It is extremely common for a parent to take their child to urgent care late in the evening and get a prescription for an antibiotic after the child is diagnosed with an ear infection. The need to specify a single pharmacy can delay treatment if the pharmacy is closed or out of the medication. The pediatrician then has to take time away from patient care to rewrite a prescription to a different pharmacy after fielding the call from the family. We think our application can leverage the blockchain to make the electronic prescription dissemination process more efficient, saving time and headaches for the patient, physician, and pharmacist.
A secure paper trail is created by sending the eRx record to Storj.
How we built it
Teamwork! A physician, front end developer, back end developer, and a graphic designer.
A hypothetical front end interface was built with angular. Solidity was used for backend coding. Health Nexus smart contracts and keys were used in the code to facilitate the transfer of eRx from the doctor to multiple pharmacies simultaneously using the blockchain. Rinkeby was used for the node. Health Nexus was chosen given their goal of a HIPPA compliant Ethereum based platform. Angular2+ was used for the front end and Solidity was used for the back end. Storj was used to securely store PDF files of the prescription record.
Challenges we ran into:
We had more ideas than time and incorporating all of ideas into this project wasn’t possible.
Accomplishments that we're proud of:
We achieved our core goal of creating a DApp that successfully exchanges prescription drug data, incorporating smart contracts designed for a healthcare platform (HIPPA compliant).
What we learned:
We learned how to create a healthcare specific smart contract using Health Nexus.
What's next for ETHRx:
Incorporate a drug database that is approved for clinical use.
Create interfaces for multiple EMR and pharmacy software systems.
Incorporate 2FA authentication to facilitate eRx of controlled substances.
Allow for data-basing of doctors who prescribe controlled substances and of patients picking up controlled substances with alert functionality.
Build networks of providers and pharmacies. That network would be integrated into an application for the patient to facilitate the location of participating pharmacies.
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