Qode Health Solutions secures COVID-19 vaccination records with the ledger feature in Azure SQL Database

Shaping new solutions in medical record verifiability

Qode Health Solutions is a South African medical technology company focused on using technology to save lives and improve quality of life for patients. The company is passionate about supporting clients and their patients with accurate, secure, complete, and valid data. 

“Much of the work that Qode does enables digitization and reporting on previously paper-based processes. Using tech to address these problems, higher quality data is captured in a near real-time environment which provides up-to-date reporting,” says Brendon Kleinhans, Development Department Lead at Qode. “These reports may then be utilized by program managers, to divert their often-limited resources to locations and populations where there is a higher need."

Due to the COVID-19 pandemic, the need to audit patient information effectively and accurately identify record authenticity in real-time became vitally important. Vaccination records were required to meet a new standard for tamper evidence. Qode needed to help clients track patient data in compliance with updated vaccine requirements in order to maintain donor funding. This created a challenge for Qode. The company needed to display updates and changes to records that would be verifiable and trustworthy to auditors, otherwise funding could be in jeopardy. Documenting and parsing these records as a way to ensure reliability became an essential part of developer operations.

Considering blockchain to display tamper evidence 

Previously, collecting patient data relied on accessing paper-based methods. Physical documents make the auditing process time-consuming and arduous, as it is harder to prove that they have not been tampered with. 

Qode needed a scalable solution that could accurately track these changes in one database that could document sufficient evidence for auditors. Data that had been stored in separate databases would need to be centralized under one umbrella so that the various touchpoints accessing and updating patient data could prove verifiability. For instance, is a patient updating their record? Is that data being updated by a medical professional? How and when are these records being updated and altered? Qode needed to capture and present all of this information for all records. 

Initially, Qode sought to build and implement a private blockchain network to document updates. While the append-only feature appeared to be an ideal use case for blockchain, investigations suggested that maintaining this new system would be incredibly costly for a multitude of reasons including energy consumption, maintenance costs, and skill acquisition.

“Setting up and maintaining a private blockchain, even with recent developments in tooling, is still a constant effort to keep it running,” says Kleinhans. “Management of smart contracts to perform the required operations also became an issue very quickly when running a private blockchain.” While employees were able to maintain this new system, it was much more time-consuming of a process for external organizations. This timeliness and communication hiccup could lead to further delays and inconveniences, which would damage trust and undermine the project’s success. 

Finding security in Microsoft Azure SQL Database

Looking for a versatile tool that could address those difficulties, Qode found Microsoft Azure SQL Database to be the closest fit for its daily operations. “We saw the ledger feature in Azure SQL Database while it was still in private preview, which led us to investigate it as an alternative to issues we were experiencing with our blockchain implementation,” says Kleinhans. Starting anew with a trusted database was a more seamless approach that made the ledger integration far easier and less intimidating, saving Qode processing power and ramp-up time.

Ledger functionality, a feature in Azure SQL Database, provides cryptographic proof of data integrity to auditors, which makes audit records trustworthy and simplifies the auditing process. Once enabled, the ledger feature will track all alterations to data. Qode stores data in ledger tables. That data contains health-record related events, references to less sensitive information that is stored off-chain, and hashes recording any modifications made to the data itself along with system data related to those modifications. 

Qode uses Microsoft SQL Server on Azure for database administration and services in Azure DevOps to manage simultaneous changes with CI/CD pipelines. Clients access data through apps that Qode created with the Web Apps feature of Microsoft Azure App Service and Azure Spring Apps.

An expedited process for all involved

Rather than needing to access multiple databases, clients can now access patient records through a single, highly secure point of access. Clients have near real-time access to tamper-evident records that meet regulatory requirements for protecting patient health records. 

“The benefit of using ledger - for clients is that there is a single, access-controlled, tamper-evident, auditable source of truth with reference to their medical record that can share data with existing systems. These technical benefits lead to better managed patient data and data aggregation that is now available to a healthcare professional that—in the past—may not have been accessible,” says Kleinhans.

By creating a more cohesive and secure experience for its clients, Qode is continuing its work using technology to revolutionize patient care. 

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