ABSTRACT
During the COVID-19 pandemic, it was necessary to validate a person's health status along with their identity to permit travel. This was facilitated via paper-based certificates and centralized digital apps. Even after COVID-19, it is anticipated that such health status verifications will be required for travel and other purposes. As a result, there needs to be an additional credential, a "Health Passport," that establishes whether a person satisfies the health requirements for various purposes. Digital credentials so prepared should be trustable, unforgeable, and verifiable. The Health Passport should be designed to protect the end-users' privacy and give people control over the data they use to confirm their credentials. This article explores the requirements for a generalized Health Passport system and uses agent-oriented modeling (AOM) to design a blockchain-based self-sovereign identity (SSI) system integrated with the Personal Health Record (PHR) to address this requirement. The article demonstrates the feasibility of the solution by implementing a proof of concept on Hyperledger Indy and Aries, integrated with the PHR - MediTrans. Credential issuance and verification time were calculated, and it was observed that the time overhead was minimal. This solution allows users to verify their credentials with the verifier without revealing any significant personal information. Our solution can be integrated into any PHR solution as the SSI solution is added as a plugin to the PHR accessible via a mobile/web app.
ABSTRACT
CASE: A 68-year-old male with a past medical history of hypertension and null smoking history presented with insidious onset dyspnea for the past three days. On physical exam, he had inspiratory rhonchi and was hypoxic, saturating to 88% in room air, requiring 6L oxygen. Laboratory studies were unremarkable, including a negative COVID PCR test. Chest X-ray demonstrated right-sided hilar prominence, and CT of the chest revealed an 8 mm endobronchial. On the day of his bronchoscopy evaluation, the patient expectorated a brownish undercooked pea while receiving nebulizer treatment and repeat chest CT revealed the resolution of the previous endobronchial lesion. IMPACT/DISCUSSION: Foreign body aspiration (FBA) has a bimodal presentation with a second peak in adults above 50 years. Although FBA most commonly presents with abrupt onset cough and dyspnea, the immediate presentation may not be evident in the geriatric population given the lack of cough reflex and cognitive decline. A retrospective study performed with data from 140 patients with FBA noted that 44.3% of patients did not present to the emergency in the first 24 hours of aspiration. Physical exam findings depend on the location of foreign body(FB) dislodgement, but around half the time, the exam could be unremarkable. A radiograph could reveal the object if the aspirated FB is radiopaque;hence a negative radiograph does not rule out the diagnosis of FBA. However, when present, the most common radiographic findings are inspiratory-expiratory abnormalities. High clinical suspicion is required to diagnose FBA to prevent chronic respiratory manifestations. An undiagnosed FB could travel distally and present as pneumonia, bronchiectasis, atelectasis, asthma/COPD-like illness. However, our patient presented with an endobronchial mass that was suspicious for malignancy. We found a similar presentation described by Bader et al. in a case about a 41-year-old woman who underwent chest CT for chronic cough, revealing a mass lesion in the right main bronchus. Bronchoscopic examination showed no growth;instead, the team found a plastic foreign body. The patient admitted aspirating this plastic object in her early 20s. If FBA is suspected, bronchoscopy is the study of choice to evaluate the airway, and extraction of FB can be performed with flexible or rigid bronchoscopy. Although flexible bronchoscopy requires only local anesthesia and a rigid bronchoscopy requires general anesthesia, the latter is safer in preventing damage to the airway. Given that each case of FBA can present unique challenges and might occasionally need endotracheal intubation or tracheostomy, only experts should perform bronchoscopic extraction of FB. CONCLUSION: In this COVID era, it is very reasonable to be anchored to a diagnosis of COVID for every patient who presents with dyspnea. FBA should be one of the differential diagnoses for geriatric patients presenting with newonset respiratory symptoms even when no physical or radiographic signs are evident.
ABSTRACT
In the current Electronic Medical Record (EMR) systems, the healthcare organizations have the ownership of patient's EMR. Patients have only limited information of the EMR in the form of discharge summary and reports. This was viewed a problem in eHealth consultations during a pandemic like COVID-19, when doctors does not have access to patient data. Patient is the owner of the data and patient should have control over his medical data and should be able to share the data according to his requirement. So currently work is being undertaken to develop patient-centric EMR system. One major challenge here is to ensure the privacy and access management of data being accessed and shared. This paper aims to solve these challenges by using a permissioned blockchain network based FHIR solution for secure interoperability. The proposed system was evaluated by developing a prototype on Quorum Blockchain. The throughput and latency characteristics of the system was analyzed with different workloads and results was promising. © 2022 IEEE.