Holochain-Based Electronic Health Records: A Segregated and Secure Approach (Published)
The management of electronic health records (EHRs) faces persistent challenges related to security vulnerabilities, interoperability limitations, and inadequate patient control. This paper explores Holochain as a transformative architecture for health information systems that addresses these issues through a distributed agent-centric approach. Unlike centralized EHR systems that create single points of failure or conventional blockchain implementations with scalability constraints, Holochain enables each participant to maintain their own immutable record chain while participating in a larger distributed hash table. We present a comprehensive framework analyzing Holochain-based EHRs across six dimensions: technical architecture, security mechanisms, patient empowerment, interoperability strategies, regulatory compliance, and implementation pathways. The proposed system shifts the EHR paradigm from institution-centric to patient-centric while maintaining workflow efficiency and regulatory adherence. Through cryptographic signatures, immutable audit trails, self-sovereign identity, and granular access controls, this architecture enhances security and patient sovereignty while improving interoperability through standardized data schemas and flexible integration options. We address regulatory compliance across diverse jurisdictions and ethical considerations regarding equitable access, concluding with implementation approaches and research directions. Despite implementation challenges, Holochain-based EHRs offer significant advantages over current approaches, warranting continued investment and exploration.
Keywords: cryptographic security, distributed health records, healthcare interoperability, patient sovereignty, regulatory compliance