Blockchain for Healthcare
on March 30th,2019

Originally developed for cryptocurrency in 2008, blockchain allows a distributed network of computers to keep a tamper-proof digital ledger.The technology, however, is useful whenever collaborating parties have competing interests that require a third-party guarantor. Large healthcare organisations have been remarkably quick to adopt blockchain.

Back in 2017, a report by IBM suggested that 16% of the 200 health care executives from 16 countries are looking forward to a release of a commercial blockchain solution. And 90% of healthcare companies already expect to execute a pilot blockchain project by 2018.

As of today, blockchain in healthcare is mostly used for audit trails and value-based care. However, it has extremely solid potential to be used for much more broader applications. This is especially true because of the rapid emergence of the Internet of Medical Things. Using Blockchain, people might be able to load clinical information directly to their smartwatches and smartphones.

Barriers to EHR Usability

Earlier, software developers in the healthcare section had limited scope due to complex, heterogeneous security requirements. According to Canada Health Info way requirements, the industry standard for EHRs (Electronic Health Records) must be able to do the following three things:

  • Encrypt data that is transmitted over mail,
  • Preserve personal health history, and
  • Verify the identity of users.

While important on its own, this security-centric EHR model truly hinders the progress instead of helping with it. Sadly, it’s the clinicians who bear the consequences of such an EHR design. Existing EHR software is currently bought and developed based on legislated standards and isn’t generally tested beforehand. This leads to gaps in adaptation by the physicians.

Blockchain can help overcome these problems. Being based on a distributed ledger, it can be used to validate clinicians’ credentials, control access to patient’s records, secure the medical supply chain, and eventually verify clinical tests.

For instance, in 2017, the US Department of Health and Human Services held a contest for the most innovative Blockchain-related ideas. The winning white paper, written by MIT’s Project PharmOrchard, was about using blockchain to power clinical trials that utilise genomic data.

Blockchain In Clinical Photography

Blockchain offers two drastic improvements as far as clinical photography is considered. These are:

  • Smart contracts, and
  • Better interface apps.

Smart contracts are data-sharing agreements between patients and healthcare providers and are automatically enforced. Blockchain can help put patient at the center of the healthcare ecosystem, enabling them to hold their own record and control who has access to it. This data may include clinical photos and flexible control over who access them and in what context (ex: diagnostic, research, before and after, academic, operative planning).

Talking about interface applications, In 2012, data scientists at Harvard recommended the SMART platform — it is an “open, standards-based technology platform” that helps innovators to securely and seamlessly operate across the entire healthcare ecosystem.

While progress has been made since that time, the Blockchain technology could make this dream a reality. Blockchain can turn the EHR market by creating a secure, enforceable, and flexible agreements.

Clinicians can take photos using their smartphones using secure, blockchain-based photography apps, and then, using smart contracts, load these pictures securely to a blockchain-savvy EHR.

While these are two extremely specific examples, Blockchain does offer lots of more holistic solutions. Blockchain has the potential to be what one surgical team analyzing the technology in the American College of Surgeons Bulletin termed, “a convergence point for health information.”

For instance, Synx, a machine learning system, is capable of mining photos of the retina to automatically predicting diabetic retinopathy, in Mexico. This is extremely helpful has ophthalmologists are understaffed relative to population. Blockchain could allow consent, capture, and storage of these photo banks and then integrate the findings from the algorithms with the EHR.

These interactions extend to many other areas of medicine with the potential of solving complicated problems like:

  • Interoperability: retaining a lifelong health record from multiple sources.
  • Personalized medicine: allowing genomic risk calculators access to DNA sequences.
  • Research: reducing siloed patient datasets and cross-correlating manual updates.
  • Security: reducing fraudulent billing, counterfeit drugs and the medical supply chain

All this just because of Blockchain and its decentralised architecture. Let’s look at it in a bit depth.

Blockchain And Decentralisation

To understand why the concept of decentralisation and running a trustworthy system is important, you need to understand the relationship humans have had with trust since the beginning of time.Early cavemen learned the importance of trusting one another – it was literally a question of life and death. A caveman, by himself, had zero chances of surviving – had it not been for the trust among them. Think of all the elements in the nature that could have killed an isolated caveman – from wild beasts to changes in the weather.

A man had to learn how to survive in communities and with people they can trust – just to successfully survive. As time progressed, you could see this trust evolve in a number of interesting and sophisticated ways.

The first clear example for this is the barter system, where people trusted each other and gave them a product of value to exchange with theirs in order to carry out a transaction. However, as time went one, the transaction system became infinitely more complex.

Because of decent medical care, our population exploded, and our businesses became a lot more complex. As a result of this, we moved from trusting an individual to trusting a centralised institution, like, say, a bank. However, as time grew, these banks became more and more powerful.

With the number of responsibilities that these banks handle, after a point it was sure that they were going to fail miserably, and the people would have to look for an alternative financial system.

This happened in 2008 – a financial collapse. Many of the banks, including the giants like Lehman Brothers, were guilty of excessive risk-taking, which shoved the whole planet into one of the worst recessions since the 30s great depression.

Disillusioned by a centrally-controlled banking system, an anon person by the name of Satoshi Nakomoto came up with the idea of Bitcoin. It was world’s first decentralised cryptocurrency, powered by the Blockchain technology.

So, how is the blockchain decentralized?

It is simple, really.All the records that are stored on a blockchain aren’t saved in one central storage unit. There are multiple computers running within the network that own a copy of all the data stored in the blockchain. That is why, whenever something gets updated in the record, all the nodes get updated and all the participants of the network get notified in real-time.

This is precisely what is meant by decentralization – there is no single source which oversees all the data anymore.

Sounds cool, right? Let’s look at how exactly can this be beneficial for the healthcare industry.

Health Care and Interoperability

Interoperability is one of the more haunting problems surrounding the healthcare domain. In fact, improved interoperability has always been a top most priority for providers, policymakers, caretakers, and even patients for quite some time now.Broadly, there are two major areas when talking about ineffective interoperability:

  • The trouble of identifying patients
  • Information blocking
The Trouble of Identifying Patients

One of the most surprising things about the healthcare industry is that there’s still no universally recognised patient identifier. This is even though organisations like HIMSS and CHIME have been pushing for its development since more than two decades.This is especially shocking when you consider the fact that a unique patient identifier will easily solve all the problems related to mismatched patient EHRs – which has in past led to a number of errors in patient care and an increased likelihood of patient harm.

This problem has been well expressed and documented by the DIrector of Center for Biomedical Informatics (CBMI), Shaun Grannis.

“Matching the correct individual to his or her health data is critical to their medical care,” he says. “Statistics show that up to one in five patient records are not accurately matched even within the same health care system. As many as half of the patient records are mismatched when data is transferred between healthcare systems.”

So, how can the Blockchain technology help solve this problem? Well, we’ll get to it in a bit. Before that, let’s look at the second problem we have here.
Information Blocking

Despite being deemed an illegal practice, information blocking remains to be a problem in the healthcare industry. But even before that, what is meant by information blocking?

In the healthcare industry, information blocking could be understood as a result of an unreasonable constraint imposed on the exchange of patient data or electronic health information. According to the US Office of the National Coordinator for Health Information Technology, these three criteria can help identify information blocking:

  • There has been interference
  • There has been knowledge
  • There is no reason for the data to not be accessible.

Pretty clearly, information blocking practices that involve unreasonable interference and awareness are a huge detriment to an effective healthcare practice. Blocking can happen because of policies that prevent sharing of information as well as those that make sharing extremely impractical.

The reason for this is straightforward – hospitals don’t want to lose out on their patients and want to make it as difficult as possible for them to move on to another hospital.

In this age of internet, this practice should have been draconian by now. But, various statistics, studies, and surveys say otherwise:

  • After surveying 60 HIE leaders, it was discovered that information blocking is extremely widespread and the various actions that have been taken to curb it are still extremely ineffective.
  • 50% of respondents that have been studied by Adler-Milstein reportedly engaged with health IT companies by participating in information blocking. A quarter of these respondents also said that hospitals and health systems are guilty of this practice.

According to the researchers, this sort of information can be cured by any of the following methods:

  • By increasing transparency so that each and every action that has been taken by the participants can be accounted for.
  • There should be a strong financial incentive so that the participants will want to share information with each other.
  • A collaborative relationship between health IT companies, hospitals, and HIEs could further curb information blocking.

Alright, so now that we have acquainted ourselves with the interoperability issues that are damaging our healthcare industry, let’s see how the Blockchain-based architecture can help solve the issue.

Public and Private Blockchains

There are two kinds of blockchains out there:

  • Public Blockchains
  • Private Blockchains

Since both are blockchains, they provide a peer-to-peer network which offers a decentralized and immutable ecosystem which are synchronized via consensus protocols.

However, that’s where all the similarities end.

Public Blockchains

Public blockchains are the ones that are most commonly used. Bitcoin, Ethereum, all are public blockchains, and the reason why they’re called so is self-explanatory.They are completely open ecosystems where anyone can take part. The network has an inbuilt incentive mechanism which is responsible for rewarding participants for taking more part in the system.

But the healthcare industry might not benefit so much from having a public blockchain.

The reason for this is that the blocks in Bitcoins and Ethereum have storage issues – as has been properly documented already. Bitcoin has a little mover 1MB of space per block, which is just not enough to store the kind of information required in healthcare.

Then, there are some throughput problems which also have been pretty talked-about. Bitcoin can hardly manage 7-8 transactions per second. Further, the block confirmation time is 10 mins which just adds to the latency. Large healthcare firms need to deal with huge blocks of data per day with nearly 0 latency. In fact, any form of latency whatsoever can be life-threatening.

So, public blockchain might not be the answer for the healthcare industry. However, there’s one more kind of blockchain.

Private Blockchains

Private blockchains are…well…private.Unlike public ones, these aren’t open to everyone. So, people who want to participate must seek permission. That is why private networks are also called permissioned blockchains.

Because of this, there are restrictions to the types of people who actually take part in the network. Access for new participants could be given by any of the followings:

  • The existing participants who are taking part in the ecosystem.
  • A regulated authority.
  • A consortium.

The private blockchains are specifically designed for enterprise needs and they offer features like:

  • Fast transactions
  • Privacy
  • High security

Because private blockchain are much more secure, these can be implemented to the healthcare ecosystem in order to solve the legacy problems.

Other Advantages of the Blockchain in Medical Healthcare

So now that we know how interoperability can be solved using Blockchain, let’s look at some more advantages that Blockchain can bring to the medical domain:

  • Being immutable and traceable, patients can easily send records to anyone without the fear of data tampering or corruption.
  • Likewise, a medical record that has been added to the blockchain will be entirely safe and secure.
  • Blockchain allows the patient to have some control over the medical data, in terms of how that is getting shared and used by the institutes. Any party that is looking to acquire medical data about a patient could check the blockchain and acquire the necessary permissions.
  • The patient can also be incentivized for a good behavior via a reward mechanism. For example, they can get tokens for following a care plan or in order to stay healthy. Also, they can be rewarded by tokens for supplying their data for trials and research.
  • Pharma companies will have extremely secure supply chain if all the data is moved on to the Blockchain. Pharma drugs are constantly stolen from the supply chain and are sold illegally to various customers. These counterfeit drugs cost these companies more than $200 Bn annually. A transparent Blockchain-based architecture will ensure these companies are able to track the drugs from the point of origin to the point of delivery.
  • Several medical institutions around the world conduct their own research trials on various new drugs and medications. A decentralized blockchain will help create one global database for all such data in one place.
  • Insurance fraud is also one of the major problems that lingers the healthcare industry. This happens when dishonest providers and patients submit wrong information/claims to receive payable benefits.
Wrapping up
Blockchain is truly an effective technology that can help prevent data breaches and offer a number of other benefits to the healthcare industry. Caregivers will definitely benefit from implementing such an architecture, while staying HIPAA compliant with this method of trustworthy digital protection. Patients, too, will be on the receiving end of much more trustworthy and secure healthcare.

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