Why Your Master Patient Index is a Central Point of Failure

A single compromised MPI exposes millions of patient records across the entire healthcare network. Centralized databases are high-value targets, with healthcare breach costs averaging ~$10M per incident and taking ~300 days to identify.\n- Attack Surface: One database, infinite attack vectors.\n- Regulatory Blast Radius: A single breach triggers HIPAA penalties across all connected entities.

MPIs create data silos disguised as hubs. They enforce proprietary data models and APIs, creating vendor lock-in and stifling innovation. True patient-centric data exchange requires a shared, neutral protocol, not a centralized gatekeeper.\n- Fragmented Truth: Competing MPIs create duplicate, conflicting patient records.\n- Integration Tax: Each new connection requires costly, custom middleware development.

Patient consent and data provenance are afterthoughts in MPI logic. Data flows are logged, not cryptographically attested, making audit trails unreliable and patient control theoretical. This violates the core principle of patient data sovereignty.\n- Opaque Access: Cannot cryptographically prove who accessed what and when.\n- Static Permissions: Granular, dynamic consent models are architecturally impossible.

MPIs are a pre-blockchain solution to a blockchain-native problem: decentralized identity. Modern architectures like W3C Decentralized Identifiers (DIDs) and Verifiable Credentials shift the paradigm from centralized reconciliation to patient-held, cryptographically verifiable identity anchors.\n- First Principles: Patient identity should be self-sovereign, not institutionally managed.\n- Future-Proof: Aligns with emerging global standards for digital identity (e.g., EUDI Wallet).

A centralized MPI consolidates PHI for millions into one honeypot. A single breach exposes your entire patient universe, unlike a distributed ledger where each record is cryptographically isolated.

• Attack surface is reduced from a data center to individual, encrypted records.
• Breach impact is contained to specific, consented data exchanges, not the entire corpus.

Your MPI creates a vendor-locked choke point for data exchange (e.g., HL7, FHIR). Every new lab, clinic, or payer integration requires costly, brittle point-to-point APIs, modeled after legacy systems like Epic's Care Everywhere.

• Eliminates custom API builds for each partner.
• Enables universal, patient-permissioned data streams via verifiable credentials.

Your MPI treats patient data as an organizational asset. This violates emerging regulations (e.g., HIPAA Right of Access, GDPR) and destroys trust. A decentralized identity model (e.g., W3C Verifiable Credentials, DID) makes the patient the root of control.

• Patients grant and revoke access via cryptographic consent receipts.
• Providers access a cryptographic proof of data, not a copy, reducing liability.

Proving chain of custody and consent compliance across a fragmented MPI and EHR landscape is a manual, forensic exercise. An immutable ledger provides a cryptographic audit trail for every data access event.

• Automates HIPAA audit log requirements with tamper-proof evidence.
• Reduces compliance overhead and legal discovery costs by orders of magnitude.

MPIs are batch-updated repositories, creating stale, conflicting patient records. Critical data (e.g., ER medication list, specialist diagnosis) is delayed, risking care. A shared state layer (like a permissioned blockchain) synchronizes a single source of truth in near real-time.

• Eliminates reconciliation delays between Epic, Cerner, and ancillary systems.
• Enables true longitudinal records for population health and AI model training.

Maintaining a high-availability, secure MPI requires massive capital expenditure on data centers, replication, and dedicated security teams—a cost passed to payers and patients. A decentralized network distributes this cost and risk across participants.

• Shifts from capex-heavy infrastructure to shared operational cost.
• Unlocks new revenue via patient-mediated data exchanges for research (e.g., genomics, clinical trials).