Enacting policies in digital health: a case for smart legal contracts and distributed ledgers?

This paper presents an approach for the enactment of policies in digital health based on our earlier work on the implementation of digital contracts in distributed systems. A formal policy model and an abstract policy language for the expression of healthcare policies are first proposed, leveraging the semantics of the ISO Reference Model for Open Distributed Processing enterprise language standard. Healthcare consent policies included in the HL7 Fast Health Interoperability Resource (FHIR (R)) standard are used to illustrate the modelling approach. Several distributed ledger and smart legal contract options were considered next as target platforms for implementation. Their benefits are highlighted along with considerations on their use reflecting business concerns of risk, trust and cost.