Developed countries spend a good chunk of their gross domestic product (GDP) on healthcare. However, hospital costs continue to mount, along with inefficient practices and health data breaches are poised to continue.
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This is one area where blockchain technology can improve the situation. It can do many things, from providing secure encryption of patient information to handling epidemics.
Estonia is a forerunner in this field, having begun to harness the power of blockchain in healthcare in 2012. Currently, its entire healthcare billing, 95% of health data, and 99% of prescription information is digitally maintained via blockchain.
What is Blockchain?
The term ‘Blockchain’ denotes a shared immutable record, of a chain of transactions, each comprising one block, with the blocks being held together by cryptographic keys (“hashes”).
These keys or signatures are stored in shared ledgers, joined by a mesh of nodes, or processes that connect them. Each node has a copy of the whole chain, being constantly synchronized and kept up to date.
The advantages of blockchain technology, according to the National Institute of Standards and Technology (NIST), include its tamper-resistant nature, the decentralized nature of the digital ledgers, and the impossibility of changing a published transaction subsequently within the user community that shares the ledger. This technology is also called digital ledger technology (DLT).
Advantages and issues with blockchains in healthcare
Key concerns with blockchain applications in healthcare include:
- Network infrastructure security at all levels
- Identity verification and authentication of all participants
- Uniform patterns of authorization to access electronic health information
DLT can be applied in many healthcare areas, but all activity within healthcare is not linked to transactions. However, public blockchains cannot be used to store private information such as identifying health data, because the data in them is widely accessible. This transparency mandates that providers consider privacy issues to ensure protected health information (PHI).
Secondly, blockchain technology is vulnerable to some types of attacks, though it offers inbuilt protection against others. The blockchain code lays it open to zero day attacks and bugs, as well as social engineering. Thus, information security must be paid intensive attention especially when used in healthcare.
Blockchain technology should not be used indiscriminately in healthcare, since its data is immutable. Large files, or those which change often, may be kept out. All identifying data should be kept off the chain.
DLT experts comment, “With new regulations on the rise, such as the General Data Protection Regulation (GDPR), in conjunction with regulations that have been around for more than a decade, such as HIPAA, patient privacy is now a standard when considering processing any form of PHI.”
The benefits of using blockchains, relative to traditional methods of healthcare database management systems, include decentralized management, unchangeable databases, data provenance, traceable data, robust data, availability of data to any authorized user, while keeping it out of the hands of unauthorized users by encryption that is dependent on a patient’s private key.
Applications in healthcare
Blockchains in healthcare can be envisaged in five primary areas:
- Managing electronic medical record (EMR) data
- Protection of healthcare data
- Personal health record data management
- Point-of-care genomics management
- Electronics health records data management
Some specific applications include the following.
At present, electronic health records allow automatic updating and sharing of medical information on a given patient within an organization or network of organizations only. This could be extended if the information was organized such that a set of information on the topmost layer of the blockchain was only that which was not PHI or personally identifiable information (PII).
This would allow researchers and other organizations to access this wide spectrum of data, with cohorts of hundreds of thousands of patients. The availability of such massive amounts of data would greatly promote clinical research, safety event and adverse event reporting and identification, and public health reporting.
Seamless switching of patients between providers
The same information on the blockchain could allow individual patients to easily unlock and share their health data with other providers or organizations, through a shareable private key. This could help to make health information technology (HIT) interoperable and collaborative between different users.
Faster, cheaper, better patient care
Blockchain can create a single system for stored, constantly updated, heath records for secure and rapid retrieval by authorized users. By avoiding miscommunication between different healthcare professionals involved in caring for the same patient, innumerable mistakes can be prevented, faster diagnosis and interventions become possible, and care can be personalized to each patient.
Interoperable electronic health records
The blockchain could provide a single transaction layer where organizations can submit and share data through one secure system, by storing a specific set of standardized data on the chain, with private encrypted links to separately stored information such as radiographic or other images.
The use of smart contracts and uniform authorization protocols can immensely support seamless connectivity.
From 2009 to 2017, over 176 million data breaches occurred with respect to healthcare records. The secure features associated with the blockchain can help protect health information much better. Each individual has a public identifier or key and a private key, which can be unlocked only as and for the period necessary.
Moreover, hacking would be limited by the need to attack each user individually to obtain private information. Thus, blockchains can provide an immutable audit trail of health information.
Mobile health apps and remote monitoring
Mobile health applications are becoming more important nowadays, with advancing technology. In this context, electronic medical records (EMRs) were found to be kept secure in a blockchain network, and the data can be sent to medical personnel rapidly, as well as being available for self-monitoring and home care as well.
This area is particularly sensitive to malware, however, particularly root exploit which can give the hacker access to the patient’s private key.
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Tracing and securing medical supplies
Blockchain can help secure, and identify the trail of, pharmaceutical supplies, with full transparency. It can even provide monitoring of the labor costs and carbon emissions involved in the manufacture of these supplies.
Health insurance claims
The blockchain is uniquely adapted to claim processing because of its ability to present medical events as they occurred, without the potential for changing the data at a later stage for purposes of fraud.
Tracking diseases and outbreaks
The unique capabilities of blockchain can help real-time disease reporting and the exploration of disease patterns that can help identify its origin and transmission parameters.
With many companies bringing DNA sequencing to the individual, genomic data theft has become a major issue. Blockchain can prevent this, and even provide an online marketplace where scientists can buy genomic information for research purposes. This could promote safe selling and eliminate expensive middlemen.
Blockchain applications are at an early stage in healthcare. Some examples of blockchain technology frameworks that are in use at present on a relatively small scale include Ethereum and Hyperledger Fabric.
With improved blockchain security and systems that promote synchronized transactions, blockchain services could be used to enhance the management of healthcare data.