Doctors and hospitals are calling for solutions to streamline EHR documentation and address cybersecurity concerns around patient health data. The most popular emerging strategy among healthcare technologists is blockchain.
What is blockchain?
Blockchain is best known as the distributed accounting platform that makes cryptocurrencies like bitcoin possible. But it also provides a secure, audit-able computing solution for many industries, including healthcare. Blockchain has big advantages as a way to record and share patient health data.
The basis for blockchain is a peer-to-peer network architecture in which members of the network record digital transactions in a shared ledger. Each time a transaction takes place, bits of code record the new information as an encrypted block.
Blockchain for healthcare
While blockchain in bitcoin would record sales transactions, in healthcare blocks capture any new information generated from a medical device or a visit to the doctor’s office. This could include bloodwork, a prescription, a heart rate reading, an X-ray, and just about any other type of medical data you can imagine.
After a physician or pharmacist validated the transaction, the software would timestamps the block of code and add it to a chain of older blocks in chronological order. This chain would be shared between providers and be publicly available. As Megan Moleteni summarizes in Wired, “The sequence shows every transaction made in the history of that ledger, whether it be bitcoin sales or a knee replacement procedure. Get it? It’s a chain of blocks. Blockchain.”
Blockchain could be used in healthcare anywhere different entities need access to the same set of complex data. The most obvious application is patient data.
Advantages for patient data
Here are four advantages of blockchain as a way to record and share patient health data.
1. Decentralized networks improve security
Existing proposals suggest that a public blockchain could be used as an access-control manager for patient data stored in EHRs. Similar to a library’s card catalog, the blockchain would be an index listing metadata like a unique identifier, a timestamp and an encrypted link to the patient’s health record.
Instead of storing tens of thousands of EHRs in a large centralized database – the way most EHR vendors do today – Blockchain disaggregates that data. Blockchain is safe because digital transactions are stored in a distributed, shared ledger. This means that hacking one block in the chain is impossible without simultaneous hacking every other block in the chain’s chronology.
2. Blockchain could solve the interoperability problem
Blockchain appeals to doctors and hospitals because it would enable secure access to a patient’s entire health history without compromising security. This could address major interoperability challenges within the health IT system.
As an open-source software, blockchain would be reliable and robust under fast-changing conditions and would help drive innovations in the application market. Using open APIs blockchain would eliminate the need for development of complexity point-to-point data integrations between different systems.
3. Users can customize access and sharing
“Good healthcare data security happens in layers,” says Brian Behldendorf, executive director of blockchain company Hyperledger. The outermost layers in a healthcare blockchain system would be a consortium of providers held to an enforceable regulatory standard like HIPAA. Further in is a networked model that ensures accountability of all users. Finally, blockchain ensures data security at the granular level of an individual patient or provider.
In a health blockchain each user would have full access to their data and be able to assign permissions to designate who can query and write data to their blockchain. As op-ed contributors recently wrote in the New York Times, this would not only make health data a tougher target for hackers but “would revolutionize who owns medical data and how it is used.”
4. Data lakes would facilitate medical research
In a health blockchain, data would be stored in a “data lake” – a highly scalable tool for storing a wide variety of data. Data lakes would facilitate health research including interactive queries, text mining, text analytics and machine learning. Every time a provider creates a medical record, a digital signature would be created to verify authenticity and the data would be encrypted and sent to the lake for storage.
Research shows that most people will generously share their health data for altruistic purposes. A blockchain model based on individualized access permissions could further research by developing broad and comprehensive datasets. This could advance understanding of diseases, accelerate biomedical discovery, fast track drug development, and support precision medicine. The shared data environment provided by blockchain would deliver a broad diverse data set with a long timeframe that is ideal for longitudinal studies.
Where are we now?
Blockchain has been thoroughly vetted through applications like Bitcoin, but the idea of using it for patient health data is relatively new. As a recent study from CB Insights summarizes, we are “still in the very early days for blockchain and healthcare applications.”
Early applications started in 2016, when an MIT team partnered with the Beth Israel Deaconess Medical Center to complete a successful pilot project using blockchain to store health data. A year later, Du announced a partnership with NMC Healthcare to implement electronic health records using blockchain.
In 2017 IBM reported that 56 percent of healthcare executives plan to have blockchain in production and at scale between 2018 and 2020. With few projects live in 2019, those estimates now seem optimistic.
Still there’s no doubt that blockchain is gaining traction. A 2018 PwC report found that 49 percent of global healthcare companies are already undertaking blockchain initiatives. When those applications are live and scalable, they could solve healthcare’s major patient data challenges.