HIE of One and the Challenge of Immunity Passports


For the last few years, we’ve been quietly working to develop HIE of One and the Trustee health record, an open source health information initiative designed by physicians, patients, and caregivers. Our volunteer, physician-led team had planned to launch a private beta later this year, but we’ve recognized the coming critical need for COVID-19 serology verification, and refocused our efforts to support a solution: the Trustee Immunity Passport™.

Will you need an immunity passport? To end social distancing? To go to work, to school, and to travel? Will we all need them? To gauge herd immunity, and inform public policy?

Immunity passports are hard. At this point, there are more questions than answers. To begin with, are they even possible?

Who will issue your immunity passport? There’s not a simple ‘yes/no’ answer to immunity. The state of the art is inadequate to determine it based on a single test. These ‘passports’ will need to be issued by experts — doctors or public health officials — in the same way that we certify restaurant health permits, only on a much larger scale.

How will this issuing process work? Blood tests that look for antibodies, no matter how accurate, don’t necessarily indicate immunity. If you have no antibodies, does that mean you need to wait until you’re infected before you can even get an immunity passport to go back to work? How often should the tests be repeated? Do you also need a swab test to check for an active infection before using your immunity passport, once you do get one? 

Since labs are not designed or licensed to interpret the test results they report, we will need trusted, credentialed third parties to issue immunity passports. They will need to consider other information, such as social contacts and travel, and health records where symptom history and risk factors are documented. When they do issue, it will need to be in a form that respects patient privacy, yet can be presented in the most useful and updatable way possible.

The Trustee Immunity Passport is a decentralized serology report that’s physician driven and patient controlled. It solves the issuance and privacy questions by treating an immunity passport in the same way it would a prescription: with secure issuer credentials; access to health records and lab results; and defined issuance and presentation workflows. It holds physicians accountable using blockchain-linked credentials. An open source, standards based design enables anyone from app developers to community groups to institutions to customize their own solution to meet the needs of their organization or population.

And, by adapting a well-understood electronic health record (EHR) code base, the Trustee Immunity Passport sets a foundation for other pandemic response applications, including contact tracing and telemedicine.

The building blocks are in place. We’ve demonstrated all of the essential components of an immunity report, and our team of physicians, clinical experts, patients, and caregivers is ready to go. We are now seeking a sponsor or committed open source developers to join us in making reporting immunity as simple and secure as showing an airline boarding pass.

Connect with us today or follow us on GitHub to learn more or get involved