Why Your EHR Vendor Fears Patient-Owned Data Architectures

EHR vendors charge exorbitant fees for data access, creating a $10B+ middleware market for basic interoperability. This stranglehold stifles innovation and inflates costs.

• Cost: $50k-$500k+ in annual integration fees per health system
• Speed: New app integrations take 6-18 months to negotiate and deploy
• Control: Vendor dictates which data points are accessible and at what price

Patient-held digital wallets (like Microsoft Entra Verified ID or Indicio) decouple identity from the EHR. Health data becomes a set of signed, portable claims.

• Self-Sovereignty: Patients grant granular, time-bound access to any app, breaking the EHR's gatekeeper role.
• Auditability: Cryptographic proofs create a tamper-evident audit trail for all data sharing events.
• Interoperability: Standards like W3C Verifiable Credentials enable seamless data portability across institutions.

Architectures like OWKIN's Substra or TripleBlind allow algorithms to run on encrypted data in-place, eliminating the need to copy sensitive datasets.

• Privacy-Preserving: Raw data never leaves the hospital's secure environment, complying with HIPAA/GDPR by design.
• Monetization Shift: Value moves from hoarding data to providing compute services, aligning incentives with patient care.
• Scale: Enables training of global AI models on distributed data without centralization risks.

EHR vendors like Epic and Cerner monetize data lock-in, charging per API call and blocking seamless interoperability. This creates $2-5B in annual integration costs for the US healthcare system and traps patient data.

• Vendor Lock-In: Switching costs can exceed $1B for large hospital networks.
• Stifled Innovation: New apps can't access data, preserving the incumbent's market position.
• Fragmented Care: Clinicians get an incomplete picture, degrading outcomes.

Protocols like Spruce ID and Disco use decentralized identifiers (DIDs) and verifiable credentials to put patients in control. Data follows the user, not the EHR.

• Self-Sovereign Identity: Patients hold cryptographic keys, not hospitals.
• Granular Consent: Share specific health records with a click, revocable anytime.
• Zero-Knowledge Proofs: Prove eligibility (e.g., age, diagnosis) without exposing raw data.

Networks like Filecoin and Bacalhau enable patient-owned data storage with programmable, privacy-preserving computation. Raw data never leaves the encrypted vault.

• Own Your Dataset: Patients store genomic or imaging data, granting compute access, not copies.
• Federated Learning: Train AI models across vaults without centralizing sensitive data.
• Monetization Control: Patients can permission and profit from research use of their data.

Mandates like FHIR and TEFCA create compliance theater, not true interoperability. They add bureaucratic layers while preserving vendor control over the core data asset.

• API Gatekeeping: Vendors provide minimal, slow, and expensive FHIR endpoints.
• Centralized Hubs: TEFCA's centralized design creates new single points of failure and control.
• No Patient Agency: The standards are institution-centric, treating patients as data subjects, not owners.

Protocols like Ocean Protocol and DataUnion.app create liquid markets for health data, aligning incentives. Patients pool data to increase its value and negotiate better terms collectively.

• Data as an Asset: Tokenize access rights, enabling transparent pricing and royalties.
• Collective Bargaining: Data unions give patients leverage against large pharma and tech buyers.
• Auditable Usage: Every access event is recorded on-chain, ensuring consent compliance.

The convergence of these protocols creates a Decentralized Physical Infrastructure Network (DePIN) for health. Helium-like models for medical devices and Livepeer for diagnostic video replace proprietary, rent-seeking infrastructure.

• Device Ownership: Patients own and share data from their wearables and sensors.
• Open Marketplaces: Algorithms and diagnostic services compete on public networks.
• EHR as a View, Not a Vault: The legacy EHR becomes just one app in a patient-centric ecosystem.

EHR vendors monetize data lock-in via per-user licensing and proprietary API fees. Patient-owned data flips this model, enabling direct, permissioned access.

• Eliminates $100-$500 per provider per month in interface fees
• Reduces ~40% of IT budget spent on integration middleware
• Unlocks real-time data liquidity for research and AI training

HL7/FHIR standards are a compliance checkbox, not a solution. They maintain vendor control over data flow and audit trails. Self-sovereign identity (SSI) protocols like W3C Verifiable Credentials and DIF Sidetree make data portable by default.

• Shifts compliance burden from $10M+ custom integrations to cryptographic proofs
• Enables sub-second consent-based data sharing vs. 30-day manual processes
• Creates an audit trail owned by the patient, not the EHR

HIPAA liability is a moat. Vendors hide behind 'business associate' agreements, outsourcing breach risk. Zero-knowledge proofs (ZKPs) and encrypted computation (e.g., FHE) allow data utility without exposing raw data, transferring security responsibility to the protocol layer.

• Replaces $20M+ annual cyber insurance premiums with cryptographic guarantees
• Enables privacy-preserving analytics on sensitive datasets (e.g., genomics)
• Turns data breaches from a $400/record penalty into a cryptographic impossibility

EHRs capture value via billing and admin modules. A patient-centric architecture unbundles these into microservices: identity wallets, consent managers, and data marketplaces. This creates a permissionless innovation layer akin to Uniswap for health data.

• Unlocks $50B+ in value from dormant clinical trial and AI training data
• Enables direct-to-patient monetization via tokenized data rights
• Reduces ~15% administrative waste in the $4T US healthcare system